In teaching Relational theory at the Tampa Bay Institute for Psychoanalytic Studies, Inc, we find we often go back to its origins in British Middle School’s Object Relations theory. What a gem is the 1958 paper of the Scottish psychiatrist/psychoanalyst W. (Ronald) D. Fairbairn. Of note, and embraced by contemporary relational clinicians today, are some of his avant garde ideas:
Fairbairn spoke to the importance of what today we refer to as intersubjectivity and included the analyst’s subjectivity in what is observed:
the subjective aspects of the phenomena studied are as much part of the phenomena as the objective aspects, and are actually more important; and the subjective aspects can only be understood in terms (p.376) of the subjective experience of the psychologist himself.' (p.377)
Negotiation (“the personal interests of both parties”) as well as the need for authentic disclosure about the needs of the analyst are discussed by Fairbairn:
It would appear to be an elementary requirement that in a therapeutic situation the restrictions of the therapeutic method employed should be imposed primarily in the interests of the patient. This does not mean, however, that the interests of the analyst should be ignored. Indeed, the greater the importance attached to the actual relationship existing between the patient and the analyst as persons, the greater the justification for recognizing the personal interests of both parties to the relationship. At the same time, if it is felt necessary to impose restrictions in the interests of the analyst, this fact should be explicitly acknowledged.(p.378)
He goes on to discuss how relationship, including analytic attitude, importantly influences outcome:
… interpretation is not enough; … the relationship existing between the patient and the analyst in the psycho-analytical situation serves purposes additional to that of providing a setting for the interpretation of transference phenomena (p. 377)
… the actual relationship existing between the patient and the analyst as persons must be regarded as in itself constituting a therapeutic factor of prime importance. The existence of such a personal relationship in outer reality not only serves the function of providing a means of correcting the distorted relationships which prevail in inner reality and influence the reactions of the patient to outer objects, but provides the patient with an opportunity, denied to him in childhood, to undergo a process of emotional development in the setting of an actual relationship with a reliable and beneficent parental figure. (p. 377)
In my own opinion, the really decisive factor is the relationship of the patient to the analyst, and it is upon this relationship that the other factors … depend not only for their effectiveness, but for their very existence… not just the relationship involved in the transference, but the total relationship existing between the patient and the analyst as persons… not just the relationship involved in the transference, but the total relationship existing between the patient and the analyst as persons. (p.379)
it is necessary for the patient's relationship with the analyst to undergo a process of development in terms of which a relationship based on transference becomes replaced by a realistic relationship between two persons in the outer world. (p. 381)
If the relationship is to change, then the analyst needs to change.
Even Systems Theory can see that Fairbairn intends a ‘perturbation’ to the rigidity of the intrapsychic life effected by the relationship’s capacity to open up transitional space:
A real relationship with an external object is a relationship in an open system (p. 381) and
the central importance of the relationship between patient and analyst as a means of effecting a breach in the closed system of internal reality (p.385)
As for the couch? what a heretic—or perhaps Fairbairn already intuited that microexpressions as communication (right brain to right brain) allowed additional and greater access to the interiority and meaning of being human:
…I have come to entertain doubts regarding the validity of the requirement that the patient shall lie on a couch with the analyst out of view.(p.378)
Something Fairbairn alludes to as of
a very high defensive value for the analyst (p.378)
Over a half century later, Fairbairn continues to speak to contemporary analysts.
Fairbairn, W.D. (1958). On the Nature and Aims of Psycho-Analytical Treatment. Int. J. Psycho-Anal., 39:374-385.
Saturday, October 13, 2012
Posted by Lycia Alexander-Guerra, M.D. at 1:49 PM