Jack Novick

Some Comments on Masochism and the Delusion of Omnipotence From A Developmental Perspective

This paper explores the relation of the delusion of omnipotence to masochism and suggests that this fantasy constitutes a major component of the resistance so prominent in work with masochistic patients. The connections among masochism, omnipotence, negative therapeutic reaction, and clinging to pain are discussed. The classical view has been that the failure of infantile omnipotence forces the child to turn to reality. Our experience with masochistic patients suggests that it is the real failure to achieve competent interactions with others that forces the child to turn to omnipotent solutions. The distinction is made between fantasies that enhance the real capacities of the self and those aimed at denying and transforming the pain and inadequacy of the mother–child relationship. The epigenetic transformations of omnipotent fantasies through all levels of development are described. The patients need to protect the omnipotent fantasy is discussed in relation to resistance at each phase of analysis.

Patterns of Termination in an Outpatient Clinic for Children and Adolescents: Agreed Termination and Nonagreed Termination

Abstract Previous studies repeatedly confirm that attrition rates are very high regardless of the type of psychiatric facility studied. The problems of attrition deserve further investigation since it is clear that offered services are going unused and patients are not getting the help that they need, which in turn has a negative impact on the professionals involved. In our review, we show that most methods of determining attrition rates result in underestimates. We arrive at an attrition rate of 85.4% and present arguments to demonstrate that this high figure is an accurate estimate. Of the 79 variables examined for association with type of termination, 19 reach statistical significance at or beyond 0.05 and a further 17 variables tend toward significance (p ≤ .10). The high proportion of statistically significant findings lends support to the validity of the categorization used to differentiate the two groups of terminators.

Love in the therapeutic alliance.

Volumes have been written about the patients love for the therapist, but there has been relatively little discussion of the therapists love for the patient. In an attempt to create a theoretical and technical space for discussing the appropriateness and role of love in the therapeutic relationship, a revised concept of the therapeutic alliance is applied to provide technical guidelines and understanding of two kinds of love between patient and therapist, corresponding to two systems of self-esteem regulation: an open, reality-oriented system and a closed, sadomasochistic system organized according to omnipotent beliefs. Examples of the role of love through the phases of treatment illustrate the interrelationship of love and the accomplishment of therapeutic alliance tasks.

An Application of the Concept of the Therapeutic Alliance To Sadomasochistic Pathology

This paper traces the history of the therapeutic alliance concept, examining how it has been used and misused, at times elevated to a central position and at others rejected altogether. The loss of this concept created a vacuum in classical psychoanalysis that has been filled by rival theories. The continuing usefulness of looking at the treatment process through the lens of the therapeutic alliance, particularly in relation to the manifold difficulties of working with sadomasochistic pathology, is suggested. To this end, revisions of the theory of the therapeutic alliance are suggested to address some of the difficulties that have arisen in conceptualizing this aspect of the therapeutic relationship, and to provide an integrated dynamic model for working with patients at each phase of treatment. This revised model acknowledges the complexity of the domain and encompasses the multiple tasks, functions, partners, and treatment phases involved. The utility of the revised theory is illustrated in application to understanding the sadomasochistic, omnipotent resistances of a female patient through the phases of her analysis.

Reclaiming the land.

Passage of the Newlands Reclamation Act in 1902 heightened expectations in Oregon that federal money would be available to develop irrigation projects in the arid regions of the state. In quick order, the newly established U.S. Reclamation Service carried out a series of surveys and investigations of the Malheur, Willow Creek, and Owyhee areas in eastern Oregon; the Umatilla district in the northeast; and the Klamath Basin in the south-central part of the state.

The Superego and the Two-System Model

The authors note that Freuds clinical struggle with the sadomasochism of his patients led directly to his theory of the superego, which in turn affected his ideas on sadomasochism. The authors use their dual-track model of two systems of self-regulation—the “closed,” sadomasochistic, omnipotent system and the “open,” competent, loving, reality-attuned system—to trace the origins, development, and functions of the “closed” and “open” superego. They suggest that the application of this model will help restore the importance of the superego in psychoanalytic theory and technique, and they provide clinical illustrations from the analysis of an older adult.

Two Systems of Self-Regulation

Abstract Our work on the development and treatment of sadomasochism and its organizing omnipotent beliefs has led us to suggest that there are two distinct kinds of conflict resolution and self-regulation. One, the open system, is attuned to reality and is characterized by joy, competence, and creativity. The other, the closed system, avoids reality and is characterized by sadomasochism, omnipotent beliefs, and stasis. This article places the two-systems model in the framework of single-and dual-track psychoanalytic descriptions of development. We suggest that a dual-track, two-systems model is consistent with Freuds vision of psychoanalysis as a general psychology, as it can encompass both pathological and normal choices throughout development and oscillations between them. Some technical implications of a two-systems model are discussed in relation to the therapeutic alliance. Applications to work with patients of all ages and the parents of child and adolescent patients are included.

Two Systems of Self-Regulation and the Differential Application of Psychoanalytic Technique

Out of our work over the years on child development, clinical technique, and sadomasochism, we have begun to formulate a model of development that describes two possible ways of responding to feelings of helplessness in the face of the challenges of internal and external experience. Any psychoanalytic model has implications for how we think about technique and can be tested on the basis of its utility in generating technical ideas and enhancing our therapeutic repertoire. At this juncture in the history of our field, it is crucial for us to demonstrate that psychoanalytic techniques are effective in helping people enter treatment, change, and finish in a way that consolidates their gains. In this paper we explore the utility of our two-systems model for expanding the discourse about psychoanalytic technique.

Trauma and Deferred Action in the Reality of Adolescence

In the search for ever earlier determinants of adult pathology many ignore the transformative impact of adolescence. The authors suggest that the reality of adolescent development creates a vulnerability to being overwhelmed. Through deferred action childhood experiences may interact with adolescent realities and omnipotent beliefs to traumatize the adolescent. The authors suggest that trauma in adolescence can be independent both of the intensity of current external exposure or of earlier traumatic experiences.

Concurrent work with parents of adolescent patients.

Over the last ten years we have seen an increasing acceptance of the general idea of working with parents of child patients. What remains, however, as an area of controversy, conflict, and resistance, is the question of whether and how much therapists should or can work with the parents of adolescent patients. Questions cluster around how to maintain confidentiality and lead to the even larger issue of conceptualizing the developmental goals of the phase of adolescence. We see the major developmental tasks for both parents and adolescents as involving transformation of the self and the relationship, in the context of separateness rather than separation. If adolescent therapists work from the assumption that the goal of adolescence is transformation, concurrent work with parents and adolescents will move them all into a new level of relationship. Without concomitant change in parents, it is doubly hard for adolescents to progress into adulthood. In this paper we offer clinical material from five older adolescents and their parents to illustrate the techniques that follow from our model of dynamic concurrent parent work throughout the phases of treatment. Using the tasks of the therapeutic alliance as a conceptual framework, we describe working toward the dual goals of restoration to the path of progressive development and restoration of the parent-child relationship. We pay particular attention to the unfolding of conflicts between closed-system omnipotent functioning and open-system reality mastery, and the role offathers in late-adolescent development.