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Book Forum: PSYCHOANALYSIS   |    
Current Theories of Psychoanalysis
Am J Psychiatry 2000;157:300-301. doi:10.1176/appi.ajp.157.2.300
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Philadelphia, Pa.

edited by Robert Langs, M.D. Madison, Conn., International Universities Press, 1998, 356 pp., $55.00.

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This is a very worthwhile anthology of current psychoanalytic perspectives, presented by experts from each area in a concise and readable manner. I was prepared to like this book less, anticipating that petty differences would be magnified into major camps, but reading it led me to conclude that it presents important variations and significant modifications of classical analysis.

Since one of the major tenets of what I will call "the new analyses" involves mutual disclosure of affects and cognitions (part of the field or dyadic, rather than a one-person, focus), I assume that a similar, au courant, self-revelatory stance is expected of a reviewer—especially when the reviewer’s biases regarding these schools and quasi-schools are apt to play a large part in the review. I will attempt to be at least as candid as I expect many of these therapists are in their disclosures (you may interpret that as you will). I am classically trained and, during the years I practiced analysis, did so in a classical manner. Ergo, I revealed little (or thought I did), touched not, abhorred so-called corrective emotional experiences, put my money on drives and conflicts, paid little attention to existential issues, and believed that oedipal conflicts were paramount in neurotogenesis (i.e., the infantile neurosis).

In the years since my formal training, the psychotherapy I do remains psychoanalytically oriented and traditional except that, like many classical (read Freudian?) analysts, I have become much more Mahlerian, pre-oedipal, object relations, and socioculturally focused, and I find existential issues more relevant. I have also become somewhat more open and more verbally interactive and share more of my feelings—including, when it seems appropriate, some of my countertransferences. I still worry about persuasions that espouse various corrective emotional experiences, both because I doubt if most of us are omniscient enough to know what stance to take or role to play and because I fear that somehow such experiences (as well as enthusiastic self-disclosure) too often are the start of a slippery slope toward acting-out with patients. (I am aware of the naiveté of such a view, of course—undoubtedly most of those therapists who act-out with their patients will do so regardless of theoretical frameworks.) Furthermore, I suspect that, in most helpful analyses, there is the same "corrective emotional experience"—the analyst as a loving, nurturing, accepting good mother—an experience for the patient that likely transcends both theory and insight in therapeutic importance.

This book has 12 chapters in all—sandwiched between a brief foreword and a not-so-brief afterword by Langs. Miller and Dorpat write on interactional theory. Gordon et al. write about relational analysis. Singer writes on the interpersonal approach, Loewus on constructivist accounts, and Lowenstein on control-mastery theory. Dorpat also writes on self psychology, the Winstons on core-conflict theory, Maidenbaum on dreams and Jungian psychology, Slavin and Kriegman on the evolutionary biological perspective, and Smith on the communicative approach. In addition there are chapters on intersubjectivity and on Melanie Klein. Langs could not include every school (and certainly not every classroom), so individual readers may wish he had included ones not selected (e.g., Lacan), but he had to make choices. Each author presents helpful clinical vignettes, and it is striking that what these therapists appear to do clinically appears generally less divergent from each other than their theoretical underpinnings would dictate.

The reader may surmise, rightly or wrongly, that I find much in the new analyses not to my liking, and readers will assimilate these chapters in accord with their own idiosyncratic views. I have an additional general criticism of those chapters which continue to address psychoses as though they were solely psychogenic in origin and, consequently, to be treated exclusively or primarily by psychotherapy. For example, in her chapter on intersubjectivity theory, Donna Orange states that "intersubjectivity theory has several leading edges. One is the effort, pioneered by its creators’ work on psychosis and borderline pathology, to reconceptualize all pathogenesis in intersubjective terms. We see psychotic delusions as concretizing particular relational experiences, including experiences in treatment and automatic expectancies." This appears to confuse phenomenology and etiology. Although we may understand the psychological meaning of the delusions of a patient with paresis, the etiology remains a spirochete; the delusions of a patients with schizophrenia may be understood intersubjectively, but the etiology remains neurochemical (perhaps coupled with as yet ill-understood psychological factors). Similar objections obtain in the chapter on Klein’s work regarding the role of interpreting the death instinct for psychotic patients.

What is most deficient in this otherwise excellent set of overviews is any detailed synthesis of the disparate or not-so-disparate views presented. Minimal effort is made to show what they have in common, what is significantly new, what is lumpable, what is irrevocably split, etc.

Interestingly, the ultimate chapter, by David L. Smith, focuses entirely on Langs’s communicative approach and, also interestingly, is the only chapter that contains an editorial plea: "Responses to Langs’ work has been largely and often vehemently negative. Sadly, there have been few thoughtful and informed criticisms of the communicative approach." In his afterword, instead of providing an overview of overviews, Langs expands on what Smith has presented, presenting more of his own theory. Both he and Smith appear to feel that communicative theory is clinically testable ("unlike conventional forms of psychoanalysis")—without presenting any convincing evidence of this. In fact, to me, it appears just as dogmatic as other schools and considerably more rule-bound (e.g., "Derivatively represented triggers can only be used in interpretations if a bridge to therapy…has also been provided" and "Interventions can only be regarded as correct if they are followed by positively toned narratives").

Like many of the authors of previous chapters in the book, Langs (and Smith) appear to feel that they have the only right and true approach to the psyche. That seems, unfortunately, inevitable when dealing with faith, but for a scientific psychology, I much prefer Roy Schafer’s narrational psychoanalytic view (as presented in the chapter on constructivist accounts)—despite its somewhat nihilistic stance.

In spite of these criticisms, Current Theories of Psychoanalysis provides a helpful survey of 12 analytic perspectives, and readers will be able to reach their own conclusions regarding the similarities and dissimilarities among them. There are at least bits and pieces of value to select from in all of them—so that one’s clinical work and theoretical understanding are likely be enriched by this work.




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