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How one thinks about the nature of what analysts know about themselves and
their patients is said to have practical implications for the way analysts work. A
social-constructivist view of the process is contrasted with both the objectivist
perspective and what is termed the “limited constructivist” view. The latter,
exemplified by Schafter, focuses only on the way theory affects interpretation. At
the heart of the more thoroughgoing social-constructivist viewpoint is the notion
that analysts cannot know the full meaning of their own behavior, both
retrospectively (in the context of interpretation) and prospectively (in the context
of deciding what to do from moment to moment). The model requires that
analysts embrace the uncertainty that derives from knowing that their subjectivity
can never be fully transcended. Nevertheless, this very uncertainty frees analysts
to “be themselves” within the constraints of the purposes of the analysis. Analysts
can now “speak their minds,” including expressing conviction about their points of
view, even sometimes when they clash with those of their patients. Both
uncertainty and conviction are present but have different meanings in
constructivism than they do in “open-minded positivism.” In the constructivist
view, what had been known before on the basis of theory, research, or cumulative
clinical experience is not discarded; rather, the authority of that knowledge is
subtly diminished in proportion to a subtle increase in respect for the analyst's
personal,
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subjective experience as a basis for what the analyst does or says. Several
examples are given of the way this attitude can affect practice.
2 I am using the term “paradigm” in its informal sense, synonymous with “model” or “point
of view,” not in the formal sense associated with Kuhn's thesis on scientific revolutions.
the reader from the substantive issues. In this connection, it may be important to
recognize that my interest in this subject derives primarily from a way of working
in the psychoanalytic situation. The epistemological discussion represents an
attempt to explicate the underlying assumptions of that way of working and of
being with patients. Of course, hopefully, that explication feeds back into the
clinical orientation and helps to shape and support it.
What I mean by the positivist or objectivist paradigm3 is a view of the process
in which analysts or psychoanalytic therapists4 are thought to be capable of
standing outside the interaction with the patient so that they can generate rather
confident hypotheses and judgments about the patient's history, dynamics, and
transference and about what they themselves should do from moment to
moment. In this model, a version of what Schön (1983) calls “technical
rationality,” the analyst applies what he or she knows on the basis of theory,
research, and previous clinical experience in a systematic way to achieve certain
immediate and long-term results. The approach is implicitly diagnostic and
prescriptive. Based on an assessment of the nature of the patient's psychological
disturbance or immediate state of mind, the analyst implements a prescribed
approach or specific intervention within one or another theoretical framework.
The positivist view does not preclude a certain kind of openness. If one approach
or intervention does not “work” or is not fruitful, another may be tried (cf. Pine,
1990). This is a very different kind of openness, however, from what is
encouraged in the social-constructivist viewpoint. I will return to this issue a little
later. I want to emphasize at this point that a central feature of the positivist view
as it applies to psychoanalytic interactions is the implication that analysts, as a
function of their knowledge of theory and of accepted principles of technique, can
be confident, not only about their sense of what their patients are doing and
experiencing, but also about the nature of their own participation at any moment.
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3 The term “positivism” is used somewhat loosely here. It corresponds roughly with the
way Bernstein (1983) uses the term “objectivism” and with the way Protter (1985) uses
“correspondence-essentialism,” that is, to refer both to literal positivism in the natural
sciences and to what Protter calls the “hidden essentialism of Neo-Kantian Interpretation”
(p. 212; also see Bernstein, 1983, pp. 8-16; Hoffman, 1991b).
4 I believe that the points that I will develop here are applicable both to psychoanalytic
psychotherapy and to psychoanalysis. For a recent discussion of the definitions of these
modalities and related terminological issues, see Gill, 1991.
A relatively well-established critique of positivism in psychoanalysis,
exemplified by Schafer (1983), applies to the kind of truth that is sought in
developing a picture of the patient's history and dynamics. In the positivist model,
it is argued, interpretations are judged in relation to the relatively hard facts of
the patient's experience, past and present. In the alternative model, which I will
refer to as the limited constructivist view, the patient's experience is thought to
be more ambiguous and malleable. Interpretations suggest ways of organizing the
patient's experience among the many ways that are possible. Suggestion, that
bugaboo of the process in a positivist framework, becomes an intrinsic aspect of
any interpretation in the alternative framework. Indeed, in an important sense,
within this framework interpretations are suggestions.5 This is not to say that one
cannot speak of one interpretation fitting the patient's experience more than
another. But there is more leeway for a range of interpretations that are
persuasive, and it is understood that, inescapably, there is some influence coming
from the side of the analyst in deciding what line of interpretation to pursue. The
“data,” that is, the patient's associations and other aspects of the patient's
behavior, cannot decide the issue by themselves. In this limited application of
constructivism to psychoanalysis, there is particular interest in the way in which
the analyst's theoretical perspective selectively shapes the narratives
encompassing the patient's history and current experience in the process.
Although I think it is valid in its own right, this limited constructivist critique
leaves undisturbed what I think of as the heart of positivist thinking in
psychoanalytic practice. In particular, it does not challenge the notion that
analysts can know the personal meaning of their own actions on a moment-to-
moment basis in the process. The attitudes that analysts maintain toward their
own actions have a retrospective aspect and a prospective aspect.
Retrospectively, the issue has to do with the kind of confidence analysts have in
what they know about their own personal contribution to their patients'
experience up to a certain time. The limited constructivist critique is riveted upon
the nature of the relationship between the theoretical bias of interpretation, on
the one hand, and the “reality” of what the patient's experience has been, on the
other. That focus, however, modifies nothing in the classical view of the
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5While this paper was awaiting publication, I came across the same statement, with
emphasis, in a paper by Stolorow (1990, p. 124).
analyst's personal involvement in the process. For example, Schafer's (1983)
“analytic attitude” is allegedly purified of personal factors through “continuous
scrutiny of countertransference” (p. 221, italics added). As in the classical model,
such countertransferences are considered by Schafer to be occasional and, in
principle, avoidable intrusions (Hoffman, 1991a, p. 81; Stern, 1991, pp. 74-
76). But, in what I am calling the social-constructivist view, it is the current of
countertransference that is continuous, not its scrutiny. It is simply impossible to
keep up, reflectively, with the stream of what Stern (1983, 1989) has called
“unformulated experience.” Only a small fraction of the potentials in that
experience can be attended to and developed through symbolic thought at any
given moment (Fourcher, 1975, 1978). Moreover, whatever is selected out of
that stream reflects the influence of specific currents of more or less unconscious
countertransference resistance at the time. In this model, just as the analyst may
see something in the patient that the patient resists, the patient may see
something, consciously or unconsciously, that the analyst resists. One of the
practical implications of the social-constructivist view is that the analyst is
encouraged to take a special interest in the patient's conscious and unconscious
interpretations of the analyst's influence (Hoffman, 1983).
What I have just said pertains to the retrospective aspect of the analyst's
attitude, the part of it that has to do with what he or she has already done, that is,
to the way in which the analyst's personal participation has affected the patient's
experience up to a given moment. The second arena that is left undisturbed by
the limited constructivist critique in psychoanalysis is the personal dimension of
prospective action. In this respect, the issue has to do with the analyst deciding
how to act at any given moment, in other words, with the analyst contributing to
making a bit of the patient's (and his or her own) history rather than merely
interpreting it. The positivist and the limited constuctivist models share the view
that the analyst can comfortably adopt the position of the relatively detached
listener and interpreter because it is assumed that that stance is favorable for the
emergence of transference, for the development of insight, and also, perhaps, for
the promotion of new experience as a by-product. In the more thoroughgoing
social-constructivist model, although the sense of the possible value of the
relatively detached stance is retained, there is also a sense of uncertainty as to its
meaning to oneself as well as to the patient at any given moment, along with
recognition that other kinds of interaction might be possible
and useful. It is important to emphasize, however, that other kinds of
participation, for example, those that seem to reflect more emotional
involvement, are no more transparent in terms of their meanings to the
participants than is the relatively detached position. working within this
perspective confronts the analyst with a new sense of risk and personal
responsibility regarding whatever he or she chooses to do from moment to
moment.
so that when the dust settles, the participants will be able to locate some aspect
of the analyst's response somewhere within the patient's patterns of interpersonal
relationships and somewhere in the patient's intrapsychic world.
6 The title of the paper, “Talking to Patients in Psychotherapy,” is associated with a good
deal of ambiguity in the paper itself as to whether and how the point Schafer is making
applies to psychoanalysis proper as opposed to psychotherapy. It is difficult, however, to
imagine that Schafer would advocate “impersonal diction” for psychoanalysts.
Authenticity, Social Constructivism, and Psychoanalytic
Discipline
I want to emphasize in conclusion that all that I have said takes for granted
that the analyst has in his or her bones a sense of certain fundamental features of
the psychoanalytic situation. The bare essentials include, I think, a circumscribed
time and place; the asymmetry of personal expression in the process; a primary
interest in exploring the patient's experience, conscious and unconscious, past
and present; a commitment by the analyst to critical reflection on his or her own
participation; and a sense of the relationship as a whole as a means of promoting
the patient's development. Every interaction in this context is experienced by the
analyst as a psychoanalytic interaction. There are no exceptions. Whether the
analyst is reacting emotionally, talking about the weather, or talking about the
patient's childhood, the stamp of the analytic situation should never be lost on the
participants.
Finally, as I have said elsewhere (Hoffman, 1991a), though a central purpose
of analysis in the social-constructivist paradigm can be described as the
deconstruction of the analyst's authority as it is represented in the transference
(Protter, 1985), the goal is also the construction of an alternative social reality in
which the patient's sense of self and others is altered. In this aspect of the
therapeutic action of the process, the analyst's authority has a powerful and
paradoxical role to play. The ritualized asymmetry of the psychoanalytic situation
(Modell, 1991; Aron, 1991; Hoffman, 1991a), however much its repercussions
are analyzed, is likely to promote an element of idealization, an extension of
Freud's unobjectionable positive transference. Along with the dialectical interplay
of the personal and the technical, the role of the analyst entails another dialectic
between, on the one hand, the combination of personal presence and technical
expertise and, on the other hand, an element of mystique derived largely from
the ritual aspects of the psychoanalytic situation. In some respects, that irrational
component in the analyst's authority, embedded in psychoanalysis as a social
institution, may lie beyond the grasp of the participants. This statement by the
German romantic Schlegel, quoted in a recent paper by Sass (1988), makes the
point: “Every system depends in the last analysis … on some … point of strength
that must be left in the dark, but that nonetheless shores up and supports the
whole burden and would crumble the moment one subjected it to rational
analysis” (p. 258). Although I do not believe that
a critical exploration of the issue by the analyst and the patient is likely either to
fully illuminate or to jeopardize the special power that accompanies the analyst's
role, actions that damage the fundamental asymmetry of the analytic situation
might well have that unfortunate effect. The kind of authenticity that I have been
talking about should not be confused with such damaging actions. On the
contrary, that authenticity actually incorporates the special kind of discipline that
the psychoanalytic situation requires of the analyst.
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