PubMed2001
Two strands of change are suggested by this review, one maturational, the other therapeutic or developmental (Hartmann and Kris, 1945). By "maturational" I mean to suggest energies that infuse the individual from earliest life in a manner that includes object relations, but for the healthy exercise of which object relations per se need not be of central and crucial importance. Within wide limits such energies may be delayed until growth conditions prevail without significant distortion of certain of the organism's ego functions. Therapeutic change is analogous to developmental change in that both involve the crucial presence of another to release energies. In therapeutic change these are energies that have been repressed beyond the reach of developmental dynamics. In everyday development crisis and synthesis alternate in conjunction with new and emerging objects to add to the psychological structures brought to the fore by maturation. In many instances, as we see with John, over time and in a less focussed manner, developmental changes can approximate therapeutic change and visa versa. Freud-Dann in their "experiment" pursued one line, in which the equipmental delay brought on by extremely adverse living circumstances was redressed by providing an interpersonally enriching, loving, developmentally facilitating milieu. The sketches of individual children and John's subsequent story provide a perspective into what becomes the stuff of growth and what remains the stuff of neurosis. The developmental reserves and ego resilience of these children were impressive but probably not extraordinary. Usual growth ensued as soon as they were provided with the rich soil of Bulldogs Bank instead of the desert sand of the Tereszin concentration camp. However, no one can escape such adverse circumstances without having taken in the stuff of neurosis. Affects and percepts that were not assimilatable or even available to consciousness at the time remain buried in the unconscious. Pain deprived of meaning is buried as neurosis. As we see in John's story, experience that cannot be integrated at the time is locked away from whatever developmental progression has occurred. Intolerable affects and ideas require particular circumstances of object relation and verbalization such as are found in the context of psychoanalysis and arrived at through psychoanalytic interpretation. Or, as in John's case, they may give way only slowly and irregularly over long stretches of time, when subjected to life experiences in the company of new object relations. Broadly stated, the Freud-Dann paper helps us to appreciate that there are several pathways of protection and growth in the ego that involve the discovery or construction of new objects. Family-romance fantasies are a common manifestation of new-object phenomena. Transitional object phenomena are also related. For some individuals at a particular time or over a span of time, providing the right circumstances for the resumption of maturational and developmental growth is all it takes to make them whole. Changes in the adaptive ego are sufficient to alleviate the conflicts stemming from the neurotic ego. For others, depending upon the degree of their neurotic impairment, or for the same individual under other circumstances, therapeutic change in the deepest sense demands the relatively unconditional presence of the interactive and interpreting other. Children of the storm who come in for shelter and warmth may thrive, but they also require a means of getting at the storm in their core that has been internalized as part of the ego's survival mechanism. What can be extracted from the poignant story of the Bulldogs Bank children about current child-analytic technique? The psychoanalytic piano now may be more formally conceptualized as having white as well as black keys. Most analyses, adult and child, have been conducted as though the "black keys"--pressure to mastery through repetition and its subsequent interpretation in relation to the transference--were the sole agents of therapeutic change. Reviewing maturation and development in relation to the resumption of psychological growth suggests that the provision of a beneficient environment, the "white keys," may lead to the resumption of maturational growth and change. The difference between the two modalities would be in the relative need for a significant other to bring about such change. Expanding on Hartmann and Kris, we can say that maturation requires a certain level of human stimulation and a supportive environment to unfold. At times in our work we encounter a psychoanalysis of and about maturation rather than primarily transference and interpretation. By and large the structure and functions of the ego that have been impeded in their exercise by traumatic circumstances in the environment are reactivated by a generalized holding environment rather than a relationship. In the practice of psychoanalysis this means that the child analyst may be more relaxed about the nonverbal play and relational aspects of the work; he need not fear that dynamics not captured in secondary process are lost to change. To the extent that the analysis provides an opportunity for maturational expression, growth will occur. When growth has been impeded by direct and significant interpersonal factors, the standard interpretative clarifications of defense, drive, and object relations in the context of removing the transference distortions regarding the analyst (and the world) are essential for recovery. Where the sequence of repetition through practice to mastery has become frozen by thwarting and stunting relationships, these potentially dead-end examples of neurotic object constancy must be played out on the "black keys." The amalgamation of the black of transference developments and the white of maturational emergence is paradigmatic for the discovery of new objects and new senses of self. In everyday life and analysis, maturation may lead to dramatic change that has hitherto been poorly identified and conceptualized. In child analysis, play is the medium for picking the lock of both arrested maturation and stultified development. Realizing that should permit the child analyst to engage more freely with the child in their own style of play without being overly concerned about the presence or absence of relational dynamic material. Non-dynamic play may not usually be defensive play, though it has often been misinterpreted as such. It may represent activity supporting renewed maturation--practice play in the service of memory, motility, or small or large motor function rather than in the service of the playful, repetitive externalization of threatening introjects. Dynamic play highlights the stagnant or emerging functions of the ego with regard to defense and affect management, which may then be interpreted using the play as key or using words as key to unlock the troubled relationship that is being dramatized. The analyst remains in a non-defensive stance, assigned by the analysand as audience or benign participant. Similarly, in adult analyses some individuals come pre-programmed not so much for interpretation as to discover the analyst as new object. They are in search of near psychobiological maturational closure on an object, already constituted in fantasy, that is respectful, attentive, objective, interested, and sometimes enlightening in their attempts at analytic understanding and developmental homeostasis. This phenomenon is akin to love at first sight, though without the flagrant libidinal romantic element. It occurs as the analytic narrative unfolds and the patient comes to a new sense of self, often around some developmental role or mix of roles, such as spouse, lover, mother, student, sibling, or worker. The point is that playing on the black and white keys of development and maturation leads to the appreciation of a psychoanalytic instrument that is at once more complex and yet easier to get music out of. And development continues from early objects to new objects. New and renewed understandings of analytic events necessarily guide the analyst in the timing of his traditional activities of attending, listening, talking, and relating. A contemporary surge of clinical understanding has led to a more active and informed relatedness on the part of the analyst that allows for a more compassionate approach to verbalization, whether with adults or children. We now know that not every word and every dynamic needs to be funneled through interpretation. The spontaneous powers for recovery that are stimulated by the analytic ground and the analytic process may come to be more accepted as a component of therapeutic gain. Appreciation of the balance of power between the verbal and nonverbal aspects of the analytic process in bringing about therapeutic change has increased. This has led to a greater parity of power and responsibility in the therapeutic alliance. The idea of a "tilted partnership" in which both members work for or against the powerful forces of the analytic process, or of a reciprocal relationship between analyst and analysand has become available to replace the former emphasis on the "tilted relationship." The analyst need no longer be so much in charge of the proceedings whether through deep interpretations of the unconscious or by obsessive attention to associational detail. The ongoing process of developing a body of theoretical and technical understanding that is both reliable and plastic demands an openness that at times flies in the face of the imperative needs of our patients and our profession for clinical confidence and certainty. The analytic clinician, part artist and part scientist, is forever struggling to balance the interminable task of culling new understanding from experience while imposing previously derived understandings that while sure are yet subject to changes stimulated by analytic experience. 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