10. On Negative Selfobjects, The Overidealization of the Maternal and Countertransference Disclosure: Some Thoughts About Therapeutic Action
Presenter: |
Christine C. Kieffer, PhD |
Discussant: |
Robert J. Leider, MD |
Self Psychology Page | 23rd Conference Program
Overview
A controversy has emerged concerning whether the experience of narcissistic rage in the analytic encounter is necessarily the result of an iatrogenically induced empathic rupture. In his 1996 paper on the "Negative Selfobject", Mark Gehrie maintained that chronic ragefulness might sometimes be the result of character distortions leading to impaired reality testing and defects in the patient’s capacity for self-reflection rather than a response to empathic failure on the part of the analyst. Moreover, Gehrie stated that he believes that such an impasse might only begin to be ended through a therapeutic dosage of "dynamite", that is, disclosure to the patient of the hurt and angry affects that the patient is evoking in the analyst. Gehrie believes that the patient experienced his (Gehrie’s) anger as evidence of an empathic attunement that his earlier interpretive efforts had failed to convey. That is, his disclosure enabled him to bypass the patient’s preverbal template of interpersonal interaction and helped to establish a context that would lead to increased capacity for self-reflection as well as a deeper understanding of transference dynamics (Gehrie, 1993). Gehrie further stated that, in his view, there is even a risk of creating an unrealistic therapeutic environment that is maladaptively attuned to the patient’s structural requirements.
Jeffrey Stern (1998) responded with a clinical illustration that he believed presented evidence in support of a more classical view of the role of empathy in fostering insight and development. Stern maintained that it was his abstention from a disclosure to the patient of the negative affects which her denigration evoked within him, and, more importantly, his attempts to convey an empathic understanding of the ways in which he had disappointed her, which enabled the patient to recover from what appeared to have been a malignant regression and led to a strengthening of structure. Stern further expressed concern that readers of Gehrie’s paper might be persuaded to begin a descent down a "slippery slope" of rationalization of aggressive behavior towards patients as being in their best interests rather than as a destructive countertransference enactment.
It is a goal of this paper to examine the conditions under which the sharing of negative reactions to the patient by the analyst can be clinically useful—even necessary. Can an empathic stance truly be broadened to include the occasional, well-timed criticism—i.e., can the mirror reveal to the patient a vision of himself as others may see him or must it only reflect how he wishes to be seen? Another goal is to suggest that the timing of such revelations is of critical significance: the analyst must first provide the needed relationship in order to create a setting in which the repeated relationship can be re-experienced and worked through. It is a contention of this paper that a well-timed, judicious revelation of negative reaction can be experienced by the analysand as both reflective of empathic attunement as well as provide an entrée into an exploration of maladaptive relational patterns.