Kohut's contribution
(1998)
Analytic child therapy techniques developed as modifications of techniques from adult psychoanalysis. Child therapy continues to be regarded as an adaptation of adult analysis and to give a central place to the methods and conditions of adult analysis, such as interpretation, in its understanding of how therapy heals. I propose that child therapy is not a modified form of therapy and that the essential processes of therapy are fully present in child therapy. In fact, they often may be seen more clearly there than in adult therapy. I suggest two interrelated processes as the essential ones in all analytic therapy. The first is play. I examine several interrelated aspects of play, specifically as they occur in child therapy. These include the emergence and integration of dissociated self-states, symbolization, and recognition. The second process I propose as essential in analytic therapy is the renegotiation of self – other relationships through action. This renegotiation is what can help patients become able to play in therapy when they have difficulty doing so. Since I suggest that action is at the heart of analytic therapy, I go on to consider the role of talking in an action therapy. Finally, I explore the dimensions of mutuality in the relationship between child and therapist, including mutual influence and regulation, mutual recognition, and mutual regression. The intersubjective nature of psychotherapy, which is increasingly appreciated in adult analytic therapy but not in child therapy, provides a fertile context for the evolution of play and for the productive renegotiation of self – other relationships.
Reply to commentaries
(2000)
When we feel overwhelmed by an inescapable threat, we >identify with the aggressor< (Ferenczi, 1933). Hoping to survive, we sense and >become< precisely what the attacker expects of us – in our behavior, perceptions, emotions, and thoughts. Identification with the aggressor is closely coordinated with other responses to trauma, including dissociation. Over the long run, it can become habitual and can lead to masochism, chronic hypervigilance, and other personality distortions. But habitual identification with the aggressor also frequently occurs in people who have not suffered severe trauma, which raises the possibility that certain events not generally considered to constitute trauma are often experienced as traumatic. Following Ferenczi, I suggest that emotional abandonment or isolation, and being subject to a greater power, are such events. In addition, identification with the aggressor is a tactic typical of people in a weak position as such, it plays an important role in social interaction in general.
To anchor my response to three issues raised by Berman and Bonomi, I rely on Ferenczi's concept of >traumatic aloneness.< First, I agree with both discussants that identification often has constructive and life-creating effects, but I suggest that it may generally arise in response to (sometimes hidden) anxiety, specifically about separation or aloneness. Second, I examine what Ferenczi termed >introjection of the guilt feelings of the adult< – trauma victims frequently feel that they are >bad< – and explore this complex feeling both as an effort to preserve others as good objects and as a way to protect oneself from a frightening aggressor. Finally, I consider the idea that trauma leads to partial psychic death. While I think it is clinically dangerous to assume that trauma can cause the actual, permanent destruction of part of the personality – this assumption can lead to unwarranted therapeutic pessimism – trauma certainly often carries the subjective experience of partial death or dying. The therapeutic effort to undo dissociations and achieve authenticity and intimacy can be thought of as rediscovering one's aliveness through the process of sharing it with someone.
It is important for every treatment that we analysts feel some room for our own subjectivity and some recognition of this from our patients. But we may feel that our analytic ideals – part of what may be called our >preexisting analytic third<: our analytic inheritance – require that we expunge our subjectivity from view. A submissive attitude toward the preexisting third may result in our committing misdemeanors in an attempt to salvage some feeling of psychic existence in a treatment where we feel negated. We can also think of a different kind of analytic third – an >emergent third< – that is mutually created by the analytic couple. This kind of third can be a platform from which to develop a necessary active, independent, and critical stance toward that which we inherit. The emergent third can find expression through the play structures that may come to shape the analytic relationship. Misdemeanors, therefore, may reflect analysts' inevitably taking on certain roles in the unconscious, restitutive, and often sadomasochistic, scenarios that patients may play out in their analyses. The possible therapeutic value of playing out these scenarios – a possibility suggested by Grand's case material – tends to undermine a clear distinction between freely surrendering to a creative analytic process, and submitting in a self-negating, though potentially helpful, way.