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Lichtenberg, speaking on behalf of his co-authors, Lachmann and Fosshage, and himself, proposed that we are now dealing with two revolutionary paradigmatic constructs, those of Kohut's Self Psychology and of Stolorow et al's Intersubjectivity, and the evolutionary theoretical development of Motivational Systems Theory (MST).
Firstly Kohut's recognition of the significance of "Primary Attachment" as it develops throughout life in the form of mirroring, idealizing and twinship needs has revolutionized the way psychoanalysts think theoretically and clinically.
Then, more or less simultaneously, a second revolution proposed, as Bob Stolorow has described, that individuality, as we had construed it, just was not the way to look at things. The influence of the new relativism and all its variations had to be rethought on a psychological level leading to Stolorow et al's intersubjective theory (IST). Hence we are dealing with two revolutions at different levels of abstraction, a point made by Stolorow with which Joe was in complete agreement.
Lichtenberg believed that he and his colleagues have evolved, in their MST, new ways of looking at development and clinical events. They have developed this new theory from different bases of information to that of Kohut and Stolorow, primarily the integration of our clinical work with our knowledge of infant research and developmental studies, It is essential to spell out the developmental contribution of each and every participant in the patient's life, each mother, father, sibling, pet etc. in the household, as it plays itself out in actual events. We cannot remain comfortably at the highest level of abstraction. In addition, by specializing, as Self Psychology has tended to do, on the primary attachment experiences, it has left out things that must be considered. He then turned to the clinical issues.
Although Lichtenberg believed that his 5 motivational systems (MS) explained things best, he agreed with Stolorow that the various combinations of them, and that various developmental pairings, e.g. patient-mother, patient-father, other family pairs etc., would pull out certain motivational configurations to the foreground more than others which may remain more in the background for any particular person. He envisages a flexible and shifting pattern according to which developmental pairing is being considered, agreeing with Bob Stolorow's suggestions concerning the importance of contextualizing, de-absolutizing and de-universalizing the motivational theory.
Turning now to issues of technique, Lichtenberg stressed that, stemming directly from the MST, he has been able to evolve important principles which contribute significantly to clinical effectiveness. In their new book, "The Clinical Exchange", he and his colleagues demonstrate Ten Principles of Technique using clinical material from an analytic case. He then turned to the three cases to illustrate some of these technical principles as they might have been applied.
He illustrated the principle of "Wearing the Attribution" with Martinez case (panel 1), a gay man who filled the hour with descriptions of his frenzied search for something in the form of sexual escapades. When her patient asked her: "Am I boring you?", she responded with a comment very bolstering to the patient's self. "You have a right to have my attention fully on you, as a child does with a mother." Lichtenberg's critique of this intervention starts with the fact that her response ignores the reality of the fact that he was indeed boring her. His approach would be to consider the fact that the patient was picking up something aversive in the analyst. He was sensing something and this might have evoked in him an awareness of aversive responses he creates in other people. Lichtenberg would try to explore that for a moment by "wearing the attribution" i.e. accepting the reality of patient's experience of the analyst. The analyst would attempt to feel her way into the patient's subjective experience of her as bored by him, starting from her own sense of her self as the one who is bored. This would lead her to be able to say something like: "Well, let us talk about it. What are your thoughts about me as being bored? Do you pick up something from me that gives you that idea?" The patient might say: "No! I'm not picking it up from you. I just know it because my mother, everybody, gets bored when I go on this way." Then they might be able to explore how he feels when he thinks of her as bored. This might start an engagement which has the potential for reaching greater depth in the selfobject aspect of the experience. Hence it is not in opposition or disagreement with this essential aspect of the relatedness, the selfobject experience. Indeed, this principle of technique aims at achieving a greater depth of exploration of it.
Another possible technical modification was suggested around the interactions in which the patient describes himself as "just horny" while the analyst attributes his sexual enactments to his disappointments in his relationship. Lichtenberg suggests two possibilities at this point. One is to focus on the different understanding each has of these events. e.g. "You know, I think we are on different wavelengths and I think you do not like it when I take you back to your partner not calling as the trigger for your sexual behavior. Perhaps you want me to understand it as just you being horny." This would be an attempt to articulate some of the aversiveness that has become part of the interaction at these points. The other is to attend to the patient's "horniness" more directly as part of his sensual-sexual motivational system in its own right, not only as a result of disappointment of his attachment needs. This is neither respectful not accurate. Lichtenberg would be more inclined to talk about his horny feelings: "How does it feel? What immediate selfobject experience are you seeking through the horny state? What lift are you getting?"
Lichtenberg closes by clarifying what he regarded as a misunderstanding of Susan Lazar's case by her discussants and Paul Ornstein. Susan was demonstrating her work during a given hour when one motivational system seemed to be clearly dominant, the exploratory-assertiveness MS. She generalizes the problem to one that many women have, the incapacity to confidently reach inside themselves and sense from within their own subjectivity, more of less differentiated from outside influences. Unable to do so they may be left with a paralysis in their assertive-exploratory functioning and find themselves unable to register a preference. Developmentally we consider the exploratory-assertiveness MS begins with the infant's scanning to explore the environment, choosing to look at one thing more than another, e.g. Mummy more than toys early and then toys more than Mummy (Meares) This is an early form of registering a preference and establishing a well functioning exploratory-assertiveness MS Susan's patient expressed the sad state of affairs for her when she said: "I would not know a preference if I fell over it." It was this that needed to be worked on in the way she demonstrated in her report. But this does not mean it becomes a paradigm for all systems because it is not necessarily so that such an organizing principle structures other systems of motivation. It may or may not be so, but that would be subject to other clinical evidence from the case, not just from the material from this system. Finally, it is the paralysis of her exploratory-assertiveness M.S. which may inhibit her capacity to seek selfobject experience in this area of self expression. Hence the importance of the focussed exploration of just this particular difficulty in this particular patient.
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