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Stuart A. Pizer, in Building Bridges: The Negotiation of Paradox In Psychoanalysis, outlines the relational model of psychoanalysis by defining its major elements (negotiation and paradox) and the parallel mechanisms by which he identifies the classical, drive-centered model of psychoanalysis (conflict and interpretation). Pizer presents his hypotheses in one major case study (the case of “Donald”) and in a number of less fully rendered case studies. In addition to explicating some of the major elements of the relational and classical models, Pizer makes it clear that he favors the relational as the more democratic model of treatment and, according to Pizer, the model that encourages the patient's purported desires and needs for equality with and autonomy in relation to the presumably more egalitarian practitioner of the relational method.
I first turn to the conflict model, which has been the major vehicle for representing the patient's presenting problem(s). The conflict model presents the patient's problem(s) as internal (e.g., a conflict between the patient's drives, in the id, and the patient's defenses, in the ego), external (e.g., involving a battle between the patient's desires, or id, and values, or superego, and the dictates of society—the external world) or both. The conflict is presented by Pizer as a choice of one of two alternatives—a decision of either one or the other alternative—whereas the model of paradox offers a choice among a number of alternatives, the decision permitting a choice of both alternatives or of either one. In the case of conflict (which is mediated through use of the classical approach), the