On the Limits of the Effectiveness of Psychoanalysis: Early Ego and Somatic Disturbances

Sylvan Keiser, the panel chairman, pointed out in his introductory remarks that the title of the panel was not intended to be understood as pejorative or constricting. He emphasized that it is not possible to provide a sharply demarcated border beyond which psychoanalysis cannot be effective as a therapy or an investigative process. Such questions arise as: What are the different criteria for evaluating "limitations" of analysis? Which patients need a preparatory phase of psychotherapy? Other problems which can effect psychic growth include external and internal deviations from an average psychological environment, congenital or acquired disabilities, and prolonged somatic or life-threatening illnesses in childhood. The panel approached these complex problems by presenting projects that originated in various frames of reference which were, in turn, discussed by the other panelists.

David A. Freedman, in his presentation, approached the problem of the limitations of psychoanalysis from the viewpoint of the implications of findings made in the course of observational research on a group of infants and children who suffered from early environmental deprivation and/or significant congenital somatic sensory deficits. He believed these cases offer a fruitful medium for the investigation of such elements of the psychic structure as the differentiation of a sense of self; the differentiation of objects as existing apart from the self; the establishment of object relations; and the development through processes of introjection and identification of such precursors of the superego as both prohibiting and idealized internal object representations. The maladaptive aspects of psychic functioning that result from deficiencies in age-appropriate experience have to be differentiated from those resulting from the kinds of experience which can be considered psychologically traumatic and anxiety provoking on the basis of defensive ego operations. For example, Freedman took iss