Several NY Branch ISPS members attended an excellent discussion on interpersonal psychoanalytic psychotherapy with persons with a severe mental illness at the William Alanson White Institute last Friday night. Paul Lippmann (known for his work on dreams-his book is "Nocturnes") gave a very engaging paper and Irwin Hirsh was his discussant. Paul focused on the person's need to "disappear." This talk inspired me to re-post some material of another great interpersonal therapist-Otto Will.
Brian Koehler
Otto Will differentiated brain from mind, rather than collapsing mind reductionistically into neural events alone: “The mind may be thought of as evidence of the interaction of the organism with its environment, reflective, in the human, of participation in earlier interpersonal fields and, to an extent, influenced by the foresight of future participation. From this point of view ‘mental disorders’ may be viewed as expressions of human experience-the formation of complex, inefficient forms of behavior whereby some semblance of human relatedness is maintained at the cost of interferences with learning, restrictions on growth, and distortions of perception...Thus the personality reflects the interaction of the biologically given with the forces of a multitude of interpersonal fields, the characteristics of each of which are largely culturally determined” (p. 279).
Will understood the connection between the development of relatedness (i.e., secure attachment), the concept of the self and the reduction of anxiety (mitigation of affective dysregulation). He noted that the psychotic patient “...fears nonbeing, and in the course of useful therapy forms a sense of self which can remain intact under the threats of nonrelatedness, panic, and death” (p. 288).His therapeutic relationship to psychotic patients is characterized by awareness of the following:
1) The patient has a simultaneous great need for, and fear of the relationship. His anxiety may increase to the point of perceptual distortion.
2) “The relationship is marked by a drawing together in which mutual identification will occur, and by a moving apart so that the concepts of self may grow through separation. A factor in what is called negativism is the need to say no and to assert oneself when one feels threatened by involvement with another. In brief, relatedness and self-identity develop together through a process of advance and retreat” (p. 289).
3) At some point in the relationship, the latter will be felt by the patient to be destructive to her or him and to the therapist, and that the outcome will be death or non-relatedness..
4) “The therapeutic process is concerned with the development of the relatedness of patient and therapist and a study of the antecedents, the course, and the vicissitudes of that development...Relatedness, insight, and action increase together. Therapy is a process of growth marked by mutuality, in which one participant cannot alter without change in the other...psychiatric illness requires in its origin and continuation the participation of others, so is the healing process one of participation [recently Harold Searles told me that he was interested in how the therapist functions in a way that keeps the patient ill]” (pp. 290-291). Will referred to Martin Buber’s (1951) comment: “A soul is never sick alone, but always through a betweenness, a situation between it and another existing being” ( quoted in Freidman 1955, p. 191).
The primary source for the above is James L. Sacksteder, Daniel P. Schwartz & Yoshiharu Akabane (Eds.) (1987) Attachment and the Therapeutic Process: Essays in Honor of Otto Allen Will, Jr., M. D., published by International Universities Press, Inc. (Madison: CT).
Brian Koehler PhD
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212 533-5687
brian_koehler@psychoanalysis.net
