About Your Next Patient: A Response to Anne Erreich

In previous writings (e.g., Levine, 2010, 2012, 2022; Levine, Reed, & Scarfone, 2013), drawing on the work of Freud, Bion, Winnicott, Green, and authors from the Paris psychosomatic school, I formulated a two-track model of psychoanalysis whose aim was to extend the application of psychoanalytic clinical theory, understanding, and practice beyond neurosis to patients and psychic organizations that had previously been thought to lie beyond the limits of psychoanalytic efficacy. In so doing, I questioned the time-honored assumptions that all impulses, actions, somatic discharges, and perhaps even some psychological states possess and reflect a fully saturated, repressed unconscious meaning and that all symptomatology is conflict based.

My reason for doing so was simply that of expediency. I found that either the ego psychologically based assumptions that I had been taught or my ability to master and use them effectively were not sufficient in helping me deal with many of the patients and/or clinical situations I was encountering in my practice. Searching outside the established canon of the American and Boston-based psychoanalysis that I had been exposed to in my training, I found increasing therapeutic success as I developed and integrated other traditions and models into a broadened view. I did not, however, challenge, much less throw away, all of conflict theory and the other extraordinary discoveries made by Freud with regard to dreams, phantasies, neurotic symptoms and organizations, and the dynamic (repressed) unconscious. Instead, I proposed adding a transformational component to Freud’s well-established archeological model, one that I

believe Freud’s later writings implied and that he was moving toward, especially after 1920 (Beyond the Pleasure Principle [Freud, 1920]), and I attempted to forge a language for this model by speaking of the unrepresse