Kenneth A. Frank

Toward Conceptualizing the Personal Relationship in Therapeutic Action: Beyond the “Real” Relationship

Abstract There is far greater theoretical coherence and clinical value in the concepts of the personal (person-to-person) and the new relationship than in the earlier concept of the “real” relationship. To develop this thesis, the author traces the historical evolution of the concept of the “real” relationship, elucidates its meaning(s), and considers its problematic features in the light of a relational psychoanalytic perspective. Although the concept of the real relationship was originally derived from the objectivist assumptions of the classical psychoanalytic model, it has thrived with relational (intersubjective) theoretical advances. Ironically, its role has become elevated in theory and practice even as its meaning has been confounded, rather than clarified, by these advances. Conceptualizations of the personal and new relationships are proposed which far more effectively articulate the goals and methods of relational psychoanalysis.

Therapeutic Action: An Introduction and Overview

Our idea for this collection of essays had been percolating for some time before NIP’s annual conference in May 2009: “Clinical Dialogues on Therapeutic Action in Psychoanalysis.” When Paul Wachtel, who presented case material there, agreed to participate in this issue of Psychoanalytic Perspectives, sharing the same generative clinical work as he had at the conference and proposing to write the conclusion, it became eminently clear that we would have the corpus of a valuable document. Conference panelist Jim Fosshage and chair David Brand likewise signed on, agreeing to write papers formulating their views for this issue and using Wachtel’s work as the common clinical example. In addition, we were pleased to extend the discussion by inviting Darlene Ehrenberg, Donna Orange, and Sandra Shapiro as contributors. Their unique voices, we felt, would add diverse and important perspectives. Ehrenberg has been an ardent advocate of authentic exchange. Orange’s background in philosophy always adds a valuable dimension to analytic discussion. And Shapiro is among the most knowledgeable people on the professional scene on the subject of trauma. They did not let us down. Finally, Kenneth Frank, spurred by the forming discussion, felt the desire to add some of his own thoughts. Emphasizing the action dimension of the therapeutic exchange, which he has discussed elsewhere as an important element of therapeutic action, he outlined that dimension as central in Wachtel’s work (Frank, 1999).

Psychoanalysis and the 21st Century: A Critique and a Vision

The author traces a current crisis in psychoanalysis to its inwardness and insularity, which have left it insufficiently progressive in relation to cultural shifts. We must more expansively open ourselves to contemporary cultural influences and connect inclusively with wide-ranging therapeutic approaches and intercultural disciplines—the arts, humanities, and sciences. This outward-leaning orientation opens psychoanalysis to interdisciplinarity, broadens its methodological integration, and promotes its growth by positioning it in the current of progress of a variety of other disciplines and psychotherapeutic schools.

Introduction to Rachel Altstein’s “Finding Words”

In her two-person drama “The Unexpected Man,” Yasmina Reza’s (1998) protagonist, a renowned author, says, “Did I write what I wanted to write? No, never. I wrote what I was capable of writing, not what I wanted to.” Initially, I thought, “That’s exactly my experience!” How wonderful it felt to see those words written by an acclaimed playwright! Then I realized that phrase may resonate with many, if not all, of us who have attempted writing, and certainly clinical writing. Rachel Altstein’s paper, for which she received NIP’s Educators’ Award in 2013, speaks to those of us who have written about our patients and to potential and frustrated authors for whom expressive words are so hard to find and assemble on the page. The Unexpected Man’s experience of writing is not so different from our own—in working with patients or writing about them; for how different are the vagaries of the writing process from those of analysis itself? To be sure, there are many differences, but there are profound similarities as well to be found between writing and our “impossible” profession (Malcolm, 1980). A patient of mine, a fiction writer who has published many novels, once characterized therapy as “novelistic.” Wilma Bucci’s (1997) multicode theory, grounded in analysis, cognitive science, and neuroscience, helps to explain some of our plight. Our inner knowing is very much a subsymbolic, right-hemispheric, intuitive affair, as is so much of how we live and what we learn—including with and from our patients in therapy. The symbolizing left brain, the hemisphere that dominates in creating writing is well suited to mastering the challenges of the external world; however, it is sadly inept at translating inner experience—our inner knowing. And so can we ever write exactly what we really “wanted” to? Can our words, even of self-description, ever be more than approximations? Or must we always, as I have entitled an article of mine, remain in part “strangers to ourselves” (Frank, 2012), especially in our written expressions, no matter how carefully crafted? Perhaps such crafting actually takes us further from, rather than bringing us closer to, what we really mean.

Still) Turning Psychoanalysis Inside Out

I recently attended a Carnegie Hall recital given by Maurizio Pollini, a concert pianist and one of my longtime favorites. Pollini, a septuagenarian born in Milan, Italy, made his Carnegie Hall debut nearly 50 years ago. Because he had canceled two prior New York City engagements due to an unspecified illness, I held my breath when Pollini, who has been called “the dean of living pianists” (Herbst, 2014), took his seat at the keyboard and began to play. To my delight, I found his performance masterful. I was pleased to learn afterward that my relatively uneducated ear led me to an assessment similar to that of New York Times reviewer Anthony Tommasini (2015), who described Pollini’s performance as an instance of “consummate musicianship and pianism.” Lost in reverie during Pollini’s virtuosic performance, I found my associations drifting in many directions, including to Paul Wachtel and his most recent book, which I was rereading at the time. As with Pollini, we have come to expect a great deal of Wachtel. And like Pollini, Wachtel again does not disappoint. His latest book, Cyclical Psychodynamics and the Contextual Self: The Inner World, the Intimate World, and the World of Culture and Society, is a wonderful, thought-provoking compilation of strong, previously published essays that the author has specifically reworked for this edition. Wachtel believes that, to our detriment, the pervasive and highly significant role of context has been terribly neglected by psychoanalytic theorists, who often “render society but a distant shadow or ghostly epiphenomenon, simply the elaboration of patterns that have already been well set before the child begins elementary school” (p. 193). In this book, he seeks to correct that error. From

A Final Response to James L. Fosshage: Some Further Thoughts on Our Respective Positions on Kohut and Therapeutic Action

The authors offer a second response to James L. Fosshage, in a dialogue concerning the depiction of therapeutic action with respect to self psychology. In addressing Fosshages critique, they respond to specific points he has made as well as reflect on the value and nature of such interactions across schools of psychoanalytic thought.

Reply to James L. Fosshage: Therapeutic Action and Self Psychology

The authors offer a response to James L. Fosshages comments on their depiction of self psychology, originally contained in their introduction to this journals special issue on therapeutic action. In addressing Fosshages critique, they take issue with his assertion that “self psychology from the beginning was structurally a relational model,” and clarify their use of the term “provision,” considering its implications for agency on the part of the patient.

Reply to the Discussants “From the Margins”

I reply to Karen Starr, Lewis Aron, and Jeremy Safran based on their discussions of my paper “Psychoanalysis and the 21st Century: A Critique and a Vision.” Basically, all agree with my assessment that psychoanalysis is facing many threats. They also offer support for the general direction I outline for approaching that crisis, and add their individual opinions.

“Complexity, Complexity, Complexity”: An Introduction to the Special Issue on Adoption

As we undertook this special issue of Psychoanalytic Perspectives, our purpose seemed clear, though we didn’t know quite what we would find as we delved into the subject of working with adoption in psychoanalytic treatment. Both of us have personal ties to adoption, and one of us (KF) significant professional experience with it; we knew going in that adoption is not seamless under the best of circumstances, that the issues are extremely complex, and that it doesn’t always seem to turn out as well as we might expect or hope. We also wondered about the changing face of adoption in the wake of sweeping social and medical/technological change over the past 50 years—why are birthmothers placing children for adoption today, for example, versus in the pre–Roe v. Wade years of the 20th century? And what about same-sex couples seeking to raise families, with or without biological ties to their children? Fundamentally, we recognized that there is a dearth of literature to guide the psychoanalyst involved in treating members of the adoption triad (or constellation) and wanted to add to that information. This approach assumes, of course, that adoption creates particular treatment needs—an assumption worth testing—and that a good number of analysts are therefore not aware of, or sensitized to, many of the relevant issues. All told, it seemed a compelling project, to want to contribute something clarifying and useful for clinicians working with patients whose lives had been shaped in some way by adoption.

Gray Cloth: Discussion of Margaret Crastnopol's “The Organismic Otherness of Being”

ARGARET CRASTNOPOL HAS WRITTEN AN INTERESTING AND wide-ranging paper exploring the proposition that “much of M our functioning as a ‘self’ occurs enigmatically in a way that cannot be seen or known directly, at the biophysiologic, organismic level of our existence.” In particular, she asserts that uncrystallized aspects of our being that reflect the biophysiological level of our existence can well up and, felt as an experience of “otherness,” carry us away from our customary sense of self. The term “organismic” has multiple meanings and can be grounded in a number of psychological theories. Usually it refers to “holism,” a term and concept co-opted by the New Age health movement, but that literally refers to the systemic organization of the person, both physically and psychologically, into an integrated whole. Crastnopol probes the organismic realm in relation to idiosyncrasies, states, and actual limits on our psychic functioning in various spheres of life that may be “more a function of our neurophysiologic makeup than of an intrapsychic constellation.” It is notable that rather than formulate a more balanced organismic approach recognizing both physical and psychological