Stolorow was very influenced by Martin Heidegger and his book, "Being and Time". He actually went back to graduate school to study philosophy, gaining another Ph.D. in 2007. Stolorow said psychological meanings were always embedded in context. He was leery of theorists who tried to objectify or "reify" the mind as a "mental apparatus," as Freud called it, because he felt that people tended to view objectified, reified "things" as independent of context. He repeated that emotional experience must be viewed in context of experience and relationships.
He said psychoanalysis should be a process of investigation that primarily looks at affects and meanings connected to affects. He said he was not very interested in the patient's behavior as a subject of psychoanalytic inquiry. That's why he called his theory an "intersubjective" model because it dealt with feelings between people rather than an "interpersonal" model that he thought related more to behavior between people.
Stolorow has been very influential to the field of psychology and psychoanalysis as well as to many of our colleagues in the Bay Area, Los Angeles, and in SFPRG. I think that he shares with our Control Mastery group an important disdain for "experience far" interpretations as well as for the tendency of some therapists to accuse their patients of "resistance" when their patients don't appreciate such interpretations. Similar to our group, he has little patience for therapists who blame the patient for negative therapeutic reactions.
One area that I disagree with Stolorow is that I think he goes too far in disallowing how "objective" we as therapists can be in understanding our patients. Whereas I agree that therapists should never presume to have a "god's eye view" of reality, I think we can effectively but humbly test our hypotheses about a patient.
Perhaps it is because I treat children, who are notorious for their inability to focus on or talk about feelings, that I think it is important to focus on behavior and try to formulate an "objective" hypothesis to explain why the child is doing what she is doing. Sometimes children can hear about feelings if the therapist draws their attention to the subject. Sometimes not. Child therapies are usually therapies by action. Children do things. Then they see what happens. In the process they may experience feelings. They may even talk about them one every six sessions if the therapist is lucky.
When treating kids, I deal with parents where I have to come up with explanations of why their kids do the terrible things they do. This exercise is partly to counter the parents' harmful explanations of why their kids do what they do. Even though explaining children's behavior is often like reading entrails, one actually can come up with a fairly useful explanation that can help parents change their behavior based on a better understanding of their child's behavior. You can explain, for example, that the child is testing the parent when he breaks a rule, rather than trying to defeat or torture the parent. Helping parents change their ideas about their kids based on a humane and feasible explanation changes the parents' beliefs and behavior toward their kids which ultimately helps undermine the child's pathogenic beliefs and helps the child get better.
Borderline and severely narcissistic adult patients can be very much like young kids, engaging in therapy by action but completely engaged in feelings and meanings without talking or listening to interpretations. It is great to talk about feelings and meanings with patients if they will allow it but I don't count on it happening with either kids or narcissistic/borderline adults. But whatever we talk about, these patients get better anyway because the therapeutic experience with my patients is in their relationship with me, how I see them, feel about them, and treat them. And my attitude depends on how I understand why they do what they do. That is where my humble hypotheses about testing, compliances and identifications come in handy. But Stolorow seems to discourage such hypothesizing suggesting that anything I think or feel as a therapist can't be objective and is probably just a transference anyway.
One of the tools that CMT affords us is an understanding/assumption that patients are trying to achieve something in their lives but their traumatic experiences may derail them. Trying to figure out that direction (the patient's Plan) and those impediments are legitimate and important goals of the therapist, according to CMT. Of course, we therapists can be wrong in our formulations. But the intersubjective writers seem to warn us off any presumption that we might know something that the patient does not overtly state.
Stolorow warned that the therapist has "the same transferences" that can muck up the therapy as the patient has. I don't thing that is true, by the way. I think patients come into therapy with an unconscious plan to work on their psychopathology by developing transferences with the therapist. I think most mature, experienced therapists enter the therapeutic relationship with the goal not to explore their own unconscious processes but to help explore the patient's. The therapist's transferences can appear in therapies with their clients but the motivation behind the therapist and client's engagement in therapy is usually vastly different.
Stolorow's warning seems to be that ultimately, the therapist can't know anything objectively because everything is subjective. I don't agree with that either. The therapist can train him or herself as an instrument that feels differently based on what different patients bring to the therapeutic interaction. I appreciate that this lofty goal is almost never purely achieved. But the opposite assertion that there is no objectivity is inaccurate in the other direction. There is quite a substantial middle ground between the arrogance of taking a "god's eye view" and the limiting assumption "you can't know anything objectively."
I may be oversimplifying this argument. Even Stolorow said he puts out "trial balloons" in therapy all the time to see what the patient will do, just as Control Mastery therapists do. His "trial balloons" must be therapeutic interventions based on some clinical hypothesis he is trying out, so he must have some clinical hypotheses he explores as do Control Mastery therapists. I'm not sure I appreciate how his theory plays out clinically, not having been in supervision or therapy with someone with this approach. I am opening the door to further discussion rather than closing it.
But I wanted to register my "resistance" to Stolorow's assertion that talking about the mind as if it were a thing, "reifying" it, means that you can't remember that psychological experience is always in a context. I'm also concerned with the implications of Stolorow's statement that he's not interested in behavior in the analytic inquiry. Why not? I think that a patient's behavior is very important and talking about it may be as powerful a therapeutic tool as talking about affects, particularly as behaviors may illustrate compliances and identifications that may be central to a patient's psychopathology.
What about obsessive-compulsive patients and other anxiety patients who avoid certain experiences and affects because of their anxiety? Cognitive Behavioral therapists and many of us who have treated these patients using a CBT and CMT approach have found that helping patients change their behavior first, before they fully explore their affects is not only useful but may be necessary before anxiously avoidant patients can change. For many patients who obsessively avoid affects and meanings and compulsively engage in safety behaviors to magically avoid perceived danger, it is necessary to address behavioral change first, and deal with feelings later.
Many self-psychologists, attachment theorists, and intersubjective theorists believe that all of psychopathology comes from poor parental mirroring and empathic failures leading to the patient having poor affect regulation. If that were true, then it makes sense that all psychotherapeutic interventions should be only demonstrations of empathic attunement. That empathic attunement would create a corrective emotional experience for all patients. The therapist holding, understanding, and empathically mirroring the patient should lead the patient to self-soothe, integrate, and better regulate affects.
But perhaps not all psychopathology results only from empathic failures. Control Mastery Theory explains that people develop specific "pathogenic beliefs" about themselves in relation to the world as a result of painful traumatic experience. Even if empathic failure is present, it may not be the only problematic thing going on in a child or adult's traumatic experience. There may be pathological compliances and identifications that create problems that go beyond the patient's difficulty self-soothing or regulating affects. Compliances and identifications are maladaptive responses to traumatic experiences where the child is motivated to protect the parent from the child's disappointment, anger, and scorn about being mistreated by acting as if their mistreatments were well deserved or by mimicking the parent who mistreated them. There may be pathogenic beliefs that the child doesn't deserve better or can't move forward in her life without implying the parent was wrong to treat them as badly as they did. There may be pathogenic beliefs that the child can't outdo the parent or leave the parent behind by acting better than they did or by becoming happy in ways the parent couldn't. These other issues go above and beyond the purported difficulty regulating affects because the child was not understood or adequately empathically mirrored.
Understanding the meanings of these pathological repetitions becomes very important in helping patients get back on track to feel more deserving and relinquish troubled symptoms and behaviors. You can't go too far wrong by helping the patient focus on affects and meanings. But some patients won't allow it. Some patients act in an impossible way despite the therapist's best efforts at empathic attunement. Usually it seems useful to me to be able to at least think about compliances, identifications, and testing when dealing with difficult patients, whether the therapist makes any interpretations about these hypotheses or not.
Control Mastery Theory seems to me to offer a wider array of options to help in the therapeutic setting. Perhaps it all looks the same to an outside observer when an experienced, talented therapist does his or her good work. I just wanted to register a few of my own "resistances" to Stolorow's prescription for what seemed to be a more limited therapeutic palette.
Steve Foreman
