Wednesday, February 27, 2008

It's Not Incompatible After All!
Using Theoretical Differences

A Commentary on Susan Sands' article, "Self Psychology and Projective Identification - Whither Shall They Meet?"

By Jacqueline Roller, PsyD

Susan Sands identified herself as a relational clinician whose work is grounded in self psychology. I was impressed with her ability to examine how self psychology may fall short of understanding some patients. I had been drawn to self psychology because it purports an empathic immersion with the patient. I previously understood this empathic stance as one of the most mutative elements of analysis. Her article made a sound argument that the empathic immersion is with the patient’s ego (concordant identification). Sands cautioned that self psychology is at risk of missing an important aspect of the patient’s internal world, namely the internalized objects (complementary identification). This article challenged me to re-examine my previous theoretical stance in order to more fully understand the patient.

Sands argued that the analyst may miss the countertransference in the empathic immersion. The analyst may be blinded from recognizing when the identification is with the patient’s internal objects (complementary identification) rather than the patient’s ego (concordant identification). The article emphasized that patients have a desire to be fully understood; including their disavowed affective experiences. Sands contends that empathic immersion promotes understanding only one aspect of the identification.

After consideration of the article, I continue to believe empathic immersion is a helpful tool for concordant identification with the patient. With this immersion I can gain greater understanding of the patient’s ego. However, I am left without an understanding of the patient’s internalized objects, namely complementary identification. This article challenges me to receive the patient’s experience of disavowed affect in order for complementary identification to occur. I believe projective identification is a useful tool for receiving the experience. The transformative element will occur when I can receive the projection, contain the experience, survive it, and then offer something different to the patient. The article builds a strong case for using the empathic immersion of self psychology while maintaining an open container for receiving the projection. If I offer a space that allows for both concordant and complementary identification there is a greater chance that the treatment will be mutative.

Sands, S.H. (1997). Self Psychology and Projective Identification—Whither Shall They Meet? A Reply to the Editors (1995). Psychoanal. Dial., 7:651-668

Jacqueline Roller, PsyD attends the New Directions program in psychoanalytic writing at the Washington Center for Psychoanalysis in Washington D.C. and is in private practice in Sarasota, Florida.

1 comment:

Anonymous said...

Kudos for a lucid paper! I very much appreciated the delineation of concordant and complementary identifications, as well as the Winnicottian perspective for the therapeutic situation. I hope to hear more from Dr. Roller