Can we Integrate the Diverse Theories and Practices of Psychoanalysis?

Ever since Wallerstein (1988, 1990) suggested that analysts share common ground, there has been considerable debate about just how common that ground is and whether our diverse approaches can be integrated, or, for that matter, whether such integration is even desirable. Schafer (1990) has noted that the problems of defining the methodology and rules of evidence within even one school of analysis are so complex that integration may forever be a pipe dream.

Meanwhile, analysts of different persuasions continue to do battle, as they have throughout the history of the discipline. In this issue Richards calls for a moratorium on these turf wars, asking for humility and open-mindedness in the way we approach the work of others. I would like to look at some of these considerations at a finer level of detail in order to try to picture how a more harmonious climate might be achieved and what obstacles may lie in the way. By way of illustration, I will start with the opening segment of a clinical hour that I have described more fully elsewhere (Smith 2000a).

My patient, a woman in her sixties, was abandoned at birth, adopted at four months, and grew up feeling out of place and unloved by her adoptive mother. Her husband has recently died, and she is herself recovering from breast cancer. But the radiation has exacerbated her emphysema, which is slowly and ominously getting worse.