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Of course, with so much on the table we need much more time for discussion and perhaps we need a plan to continue the discussion next year rather than leave so much hanging and unresolved. But a few things can be said.
Kohut's two attitudes towards theory were essential for the formulation of his new ideas. These were:
1. Theories are merely tools of observation and we should not get wedded to them.
2. We should use our theories playfully for as long as they help us understand the clinical context, the patient and ourselves, and the process that develops between us.
As an ego psychologist, Kohut took his theory very seriously, even to the point of rigidity. He later confessed that his rigid defense of those concepts may have been his response to a crumbling system which he did not want to let go of.
Paul finds himself against integration because theories are "inherently antagonistic" (Goldberg, Kuhn). It is the clinical issues we need to elaborate on. Bob says we need a theory to investigate our theories, then we may need a 4th or a 5th one in order to accomodate it all. He was not yet convinced that the meta-theory Bob Stolorow proposes really so smoothly accommodates all currently existing theories. Paul returned to his previous doubt about the capacity of intersubjective theory (IST) to accomodate a theory, such as drive theory, which explicitly refutes its basic premise, that all psychological phenomena occur in an intersubjective field (ISF). Paul expressed doubt that such a meta-theory gives room, event to self psychology, although, this weekend, he had found Bob and others to be agreeing that the self-selfobject matrix was important. "In the past this was shunted aside and my earlier reactions were based on that. My new reaction is based on what I have found here this weekend, especially hearing George Atwood's explication of his approach to psychotic patients. He found a central place for the self-selfobject context within his broad IST. This is something we need to think about and examine more on the basis of further clinical material."
(Partly in jest) "Paul, you have to stop confirming my most invariant organizing principle which is that 'Nobody ever listens to me!' I've been affirming the importance of the selfobject dimension of experience and the selfobject dimension of transference ever since I can remember, so this is certainly not the first time I've said that!" In the past, Bob suggested, his position may have been obscured by other things he had said in his attempts to place Kohut's ideas in a larger framework having to do with the organization of personal experience and its vicissitudes with an intersubjective context. He agreed with Paul's position regarding the impossibility of integrating drive theory, or self psychology for that matter, as a metapsychology, with IST. He suggested that Donna Orange, in her panel presentation, did not really mean that. He suggested that what she realy meant was that: "the contributions of drive oriented thinking can be integrated with the intersubjective perspective (ISP) if they are contextualized."
Freud made some valuable contributions at the level of affective theory which we don't have to throw out. Bob referred back to his earlier comments about the Oedipus Complex. If we do not consider it as a manifestation of innate prewired endogenous drives that will occur universally because they are biologically built in, but, instead as a metaphor for certain powerful affective themes that can become central in development and in pathogenesis for some people under some intersubjective circumstances, then I think that that clinical understanding can be integrated with the clinical understanding of other points of view such as self psychology etc. The key point here is the contextualization, the de-absolutization and the de-universalization of the concrete clinical knowledge acquired through multiple clinical theoretical points of view.
Bob then referred to Donna Orange's case presentation not as an attempt to demonstrate optimal or perfect technique utilizing the principles of IST. Instead, he suggested, her case presentation was intended by her to demonstrate the ways in which her clinical interventions were both facilitated and impeded by the unique ways in which her subjective world, her history of traumatization and dissociation and the patient's subjective world, the patient's history of traumatization and dissociation, interacted with each other. Further, she was demonstrating how sometimes that interplay was facilitative of the clinical process and of Donna's interventions while at other times that interplay impeded the clinical process and Donna's clinical interventions.
Donna affirmed that she was in agreement with Bob's explication of her purpose in her case presentation but had some comments about the issue of integration of all psychoanalytic theories with IST objected to by Paul, and commented upon further by Bob. She proposed that it was "not that the theory can be included within the ISP but that the ISP describes any psychoanalytic dyad. So if we consider a classical Freudian analyst working with a patient, we have an intersubjective ISF in which particular sorts of things will happen or not happen." That is what Donna meant when she said that the ISP describes what will happen in any psychoanalysis, no matter what the theory of the analyst may be.
Joe Lichtenberg entered the discussion at this point, and before going on to make his 3 minute response, he commented that Donna Orange was now separating between IST as a tool for investigation and IST as a meta-theory, two uses which he felt tended to get muddled. Using IST as a tool for investigation we can investigate any dyad operating in any way by attending to the subjectivities of the two participants.
Joe began with a comment about Paul's criterion for theory modification i.e. that such a change in theory must be "clinically compelling" for him to consider it as necessary or acceptable. Although this is a fair challenge, it must be acknowledged that that such a decision will be significantly influenced by the subjectivity of the person determining what is, or is not, clinically compelling. He then went on to attempt to provide some compelling reasons as to why motivational systems theory (MST) should be considered within the field of self psychology as something additional to the selfobject needs identified by Kohut. He suggested that there are other needs involved with the cohesion of the self besides Kohut's familiar ones. This being so, he contended that these needs should be raised and discussed in the analytic situation, and to do so, they have to be identified. Furthermore, the problems associated with them also need to be identified and worked with. This was, for Lichtenberg., right at the heart of the issue. For example, if the cohesion of the self depends of being fed, then a patient with anorexia must need something about that [source of self cohesion and or vitalization] included in the exploration of her experience. This can be said of many such motivational experiences.
In addition, any person's motivational systems are continuously in a self-regulatory mutual-regulatory flux so it is essential to be aware of each person's dominant motivation(s), not just the needs for mirroring, idealizing and twinship, at any point in time in order to fully comprehend the ISF. This plus the capacity to identify the particular quality of selfobject experience being sought by attending to affects particularized to different kinds of life experiences, Lichtenberg believed were compelling enough reasons to accept the evolution of MST within the revolutions of IST and Self-selfobject theory.
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