Trauma, Conflict, and Countertransference: A Discussion of Thomson's Paper

As usual, Peter Thomson has presented a vivid clinical case that is honest and revealing enough to allow us to see some of the inner workings of the analyst's mind. He uses the case to illustrate a self-psychological conception of trauma that, for the most part, I find compelling. I will focus this brief discussion on one issue: the lack of a clinical or metapsychological understanding of the actual conflicts of interests between therapist and patient that were also revealed in Thomson's candid case presentation. It is my sense that, despite operating without a theory of inherent interpersonal conflict to guide him, Thomson successfully negotiated the conflict in interests with the patient in a manner that allowed the patient to move forward in the therapy and his life. I will try to show where I saw this conflict and how we can conceptualize it more clearly.

First, I must acknowledge that self psychology, in both theory and practice, does struggle with conflict—both intrapsychic and interpersonal. However, there is an absence in self-psychological theory of a notion of inherent, significant interpersonal conflict (Kriegman and Slavin 1990). Despite Kohut's (1980, 1983, 1984) acknowledgement that conflict is ubiquitous (and not necessarily unhealthy), there is no source in self-psychological understandings of human motivation to explain why it is ubiquitous and so problematic. Though theorists like Lichtenberg (1989) have developed conceptions of innate aversive motivational systems, almost all self-psychological discussions of genuinely problematic interpersonal and intrapsychic conflict—especially conflict in the clinical relationship—focus on some selfobject failure at some point, not on a genuinely problematic conflict of interests.