In response to the success of Monograph One, Models of the Mind: Their Relationship to Clinical Work and the recent publication of The Reconstruction of Trauma: Its Significance in Clinical Work, Monograph Two of the Workshop Series of the American Psychoanalytic Association, we asked Dr. Rothstein to write an article about the Workshops for Mental Health Professionals of the American Psychoanalytic Association and the resulting series of publications they have engendered.
The Workshops for Mental Health Professionals were initiated in 1976 by the Program Committee of the American Psychoanalytic Association with the heuristic aim of offering to the entire mental health community the expertise of analysts in regard to fundamental subjects of concern to practitioners in the field. It seems important to add that while the workshops are organized for the broad spectrum of mental health professionals, they are, nevertheless, of the highest order; they include papers that are clear and reasonably devoid of unnecessary jargon so as to be of interest to and understood by colleagues with a variety of professional training and expertise. The Program Committee's aim to collaborate in this way with the larger mental health community derives from its wish to reach out to this group and to encourage their attendance not only at the workshops but at national meetings as well. The conviction is psychoanalysis is a general psychology applicable in modified forms to many aspects of other clinical as well as nonclinical endeavors.
Past workshops have explored a number of subjects of basic interest to mental health practitioners: Special Problems in the Treatment of Adolescents; Special Problems in Brief Psychotherapy; Children's Reactions to Object Loss; Special Problems in the Psychotherapy of Depression; and, The Transference in Psychotherapy: Clinical Management.
In 1972, when I became chairperson of the subcommittee of the Program Committee on Programs for Mental Health Professions, I initiated a change in the format of these workshops which serendipitously facilitated the process of developing the workshops into a series of basic books. Prior to 1982, the workshops consisted of two panels on two consecutive mornings, followed by small group discussions. Since 1982, the workshops have been conceived to ask a basic question about the relationship of a fundamental theoretical subject to clinical work. Workshops begin with my introductory remarks, raising basic questions about the subject being considered. To provide an organizing and facilitating framework, workshop participants are sent these remarks well in advance of the meeting. It offers as well a comprehensive historical review of the subject which further contributes to establishing the foundations of the meeting. These presentations occupy the first hour of the meeting. The remainder of the first day of the workshop consists of two successive panels. In 20-minute presentations, each panelist represents his or her perspective on the subject, along with clinical material illustrating the underlying theoretical viewpoint. In this way, abstract discussion is avoided and the workshop is grounded in clinical data. A particular innovation in this series is the second morning's panel entitled, Conversations with the Panelists, a three and one-half hour session beginning with two formal discussions of the presentations heard the previous day, followed by several hours of spontaneous discussion among the entire faculty of the workshop and between them and the audience.
The sponsorship of the workshops by the Association has insured participation by leading contributors to the important subjects being considered. At this point in the history of psychoanalysis, considerable differences of opinion exist on basic issues, as well as on the methodology to explore these differences. Thus, our format is designed to provide a presentation of the history of the subject, a number of contemporary perspectives on the subject, and an in-depth discussion of the points of agreement and disagreement.
Responding to the high caliber of the resultant learning experience, many participants have suggested that a written record of these proceedings be created toward which end the Executive Committee has sponsored a series of publications deriving from these educational endeavors.
Drs. Paul Dewald, Richard Isay, Shelly Orgel, Melvin Scharfman and Rebecca Z. Solomon function as Associate Editors of this project. Their input has contributed significantly to the process of developing the presentations into chapters in the monographs of The Workshop Series. As indicated, the workshops are each designed to explore a basic question; each resulting publication, however, concludes not with “an answer”, but instead with “a state of the question”. Thus, while the workshops leave us with as many questions unanswered as answered, unanswered questions serve, in part, as indicators for future work and as spurs to research. In addition, these questions influence the planning of future workshops.
To illustrate, I will describe briefly the sequence as it is reflected in one workshop, the 1984 offering on The Significance of the Reconstruction of Trauma in Clinical Work. To outline this process provides a glimpse into the workshop itself, its evolution into Monograph Two of The Workshop Series and its elaboration into the current workshop, How Does Treatment Help?, which was stimulated by its predecessor.
My introductory remarks to the 1984 panel placed the subject in its historical context, noting that:
Freud's earliest hypothesis suggested perversion in the seducer produced hysteria in the seduced. This concept shaped early models of psychoanalytic treatment, an aim of which was the recovery of infantile traumatic memories and their abreaction. Freud's discovery of infantile sexuality influenced him to revise his conceptions of pathogenesis and mode of therapeutic action, placing a much greater emphasis not on what actually happened but on what a child fantasized and believed to have taken place. Fantasy and the creative aspect of the mind was stressed rather than the recording of actual memories.
An unresolved difference of emphasis
Page 3is still with us as to the relative significance of the actual traumatic event as compared with the importance of the child's subjective experience. This difference is not of an either/or nature but is instead one of emphasis. It can be seen clearly in the contributions of Greenacre and Kris, and elements of it are evident in some of the more recent contributions to the subject of mode of therapeutic action (; pp. 1-2).
I recalled in my remarks that Greenacre had stressed “the organizing effect” (p. 643) of “a single disturbing experience verifying the infantile fantasy and making it powerfully real” (p. 643), while Kris had emphasized the analyst's delineations of fantasy-producing patterns within the mind. Kris noted, “it is with these patterns rather than with the events that the analyst deals” (p. 77).
Employing this fundamental difference in emphasis as a frame of reference for the tasks of the workshop, I noted to the audience: Contemporary mental health practitioners live in a world in which they are confronted with a variety of models of the mind competing for their admiration and allegiance. Each of these models assumes somewhat different understandings of the definition of psychic traumata, of their importance in pathogenesis, and of the significance or their reconstruction in clinical work. In addition to its heuristic purpose, the workshop was organized to explore the theoretical and clinical validity and usefulness of these models. Toward that end, the panelists were asked to present clinical material reflective of their reconstruction of an experience they considered traumatic. They were asked a number of questions intended to facilitate the development of their contributions:
How did your organizing theory influence your thinking on the subject of the reconstruction of trauma and your work with the patient? In that regard it is noteworthy that Kris felt that the interest in the recovery of “new” memories derived from outmoded models of hysteria while his ideas were generated from a modern ego psychological perspective. More recent hermeneutic considerations suggest that the data of the analytic experience is created within the dyad rather than recovered from memory, and that it is very significantly shaped by the analyst's theoretical commitments. Other recent theoretical emphases on the value of the here-and-now aspect of transference interpretation also seem to de-emphasize the importance of the reconstruction of trauma in clinical work.
In those subjects who experienced shock trauma, how had previous strain trauma shaped the child's reactions to the shockingly traumatic event? Do you find the distinction between shock and strain trauma of value? Where your reconstruction involved formulations concerning hypothesized experiences of strain or shock trauma of the preverbal epoch, please describe the clinical data employed in their derivation.
How did the developmental tasks in progress at the time of the trauma influence the subject's experience of it?
What effect did the trauma have on the child's character development and the resulting clinical picture? It has been suggested by Greenacre and Segal that defensive identification is a frequent response to trauma. Was defensive “identification with the doer” and acting out characteristic of your patient?
Finally, what did you seek to accomplish with your reconstruction? What data did you employ to substantiate its validity? What was your reconstruction's mode of therapeutic action? (pp. ).
The Monograph that resulted from the panelists' attention to these considerations is organized in three sections: Section I: Theoretical Considerations consists of three chapters written by Harold P. Blum, Sidney S. Furst and Arnold M. Cooper, which chapters provide a comprehensive theoretical frame of reference for the rich clinical material of the second section. In Section II: eight colleagues present clinical material organized from their respective theoretical frames of reference that vividly demonstrate their reconstruction of specific traumas. These include: Brandt F. Steel on Child Abuse; Robert D. Gillman on Physical Trauma and Actual Seduction; Sander M. Abend on Sibling Loss; George H. Pollock on Abandonment; Eleanor Galenson on Divorce; Joyce McDougall on Parent Loss; Milton E. Jucovy on The Holocaust; and Anna Ornstein on The Holocaust. Section III includes two discussions of the various contributions written by Charles Brenner and Scott Dowling, as well as an appendix and a concluding chapter written by me. The appendix is in the nature of a panel report in that it summarizes the spontaneous discussions of the workshop.
The concluding chapter aims to anticipate and influence the future by clarifying questions in general and by defining in particular questions that might be the focus of future meetings. I note:
In concluding this monograph, it is clear that fundamental questions in regard to the reconstruction of trauma have not been answered: What is psychic trauma? What is reconstruction? How does reconstruction happen in a therapeutic experience and how does it help a patient considered to have been traumatized? In the process of discussing these basic questions, three relatively different organizing perspectives became clarified by virtue of their distinctive emphases. I will designate these theoretical perspectives: the hermeneutic, the developmental and the adaptational. In addition, it was clear that such a process of discussion was not only intellectually interesting and of heuristic value but it also contributed to the formulation of questions which beckon contemporary and future colleagues to develop additional research methodologies to further elucidate the significance of the reconstruction of trauma in clinical work (p. 219).
In pursuing the question, “What do we mean by the term psychic trauma?” I suggest that:
… three different definitions of trauma emerged from the contributions to this book. While similar in certain respects, these definitions are quite different in their emphases. A hermeneutic definition of trauma stresses the mind's interpretation of the meaning of an external event. Although all contributors to this book would affirm the profound importance of the subjective meaning of an event to an individual, some would stress other factors. From a developmental perspective, it is suggested that it is the absence of a maternal protective shield that determines an event's traumatic import (pp. 222-223).
From an adaptation point of view, the overwhelming of the ego's integrative capacities is stressed. I continue:
Those who stress the meaning of an event seem to assume that the mind's interpretive capacities are either always intact or are of predominant importance … in contrast to those who stress the mind's adaptive capacities and assume that the mind's interpretive abilities are overwhelmed and temporarily suspended, such that the mind functions on a more primitive level of integration Beyond the Pleasure
Page 4Principle. They suggest, as Freud did from a developmental perspective within the rubric of “the original function” (p. 33), that the characteristics of the mind are different when massively traumatized, and that all people have the potential to regress to this level of function. From this perspective, the meaning of the event, while important, is secondary.
Psychoanalysis was created in a mind that was prepared, in part, for that creative experience in the neurohistology laboratory and the neurology ward. Although Freud attempted to create a psychoanalytic theory that was purely psychological, he was always interested in the relationships of his psychology to biology. At the present time we are unable to create a theory that integrates the relationships between the mind and the body in a satisfying way. Those who stress meaning in their definition of trauma present a definition that is purely psychological. Those who stress adaptation are more interested in a definition of trauma that appreciates the biology of the organism and attempts to bridge the realms of biology and psychology.
These three definitions of trauma, the hermeneutic, the developmental and the adaptational exert a significant influence on derivative conceptions of reconstruction and mode of therapeutic action (p. 223).
In response to the question, “What do we mean by reconstruction?”, it was noted that:
The three definitions of trauma suggest somewhat different understandings of the meaning of reconstruction. From a hermeneutic perspective the task of reconstruction is the restoration of a more rational understanding of an experience. In particular the distorting influences of unconscious fantasy producing patterns are interpreted. From a developmental perspective reconstruction facilitates a reconstitution of the maternal care-giving function, while from an adaptational perspective reconstruction facilitates the restoration of adaptive organization (p. 225).
In response to the question, “What are the modes of therapeutic action of a reconstruction?”, it was noted that:
The three definitions of trauma, and the derivative conceptions of reconstruction influence conceptions of mode of therapeutic action. All conceptions conceive of the analyst providing something new for the “traumatized” patient. The analyst functioning from a hermeneutic perspective conceives of himself as facilitating integration through the act of interpreting. Interpretation provides insight which facilitates integration. The analyst as object or as “new” object is less important in this conception of mode of therapeutic action. Analysts functioning from a developmental and/or adaptational perspective conceive of the therapist as new object as essential to the therapeutic process. An analyst functioning from a developmental perspective conceives of himself providing a maternal function that was absent during the traumatic experience (pp. 227-228).
In regard to an adaptational perspective, it was noted that from that perspective the analyst can be conceived as functioning as a new object to facilitate organization. Although the secondary meanings of the events are important, the assimilation of terrifying and painful affects associated with the events seem of greater significance. The importance of the therapist's capacity to tolerate these painful affects is emphasized.
Finally, I noted that: “In concluding this book a number of questions emerge from an effort to understand the influence of the different theoretical perspectives suggested by various colleagues” (p. 228).
I then listed and briefly commented on these questions:
Do these alternative theoretical views of trauma, reconstruction and mode of therapeutic action affect what analysts do and how they actually function in their clinical work? This book clearly demonstrates that although colleagues use the same terms to describe what they do, these terms have a variety of meanings. It is also likely that different colleagues function differently in their clinical work. It seems probable that within the term “analysis” there are a number of analyses practiced by a variety of analysts for a spectrum of patients. What one colleague designates as analysis another might consider a supportive psychotherapy. Alternatively, it is possible that all competent analysts do something more similar than different in regard to their clinical work, regardless of how they think about it.
Kohut pointed out that successful Freudian, Kleinian and Kohutian analysts all helped their analysands. He suggested that one way of understanding this phenomenon is to consider that it is not the specifics of their interpretive strategies that are important but rather their nonverbal functioning as responsive selfobjects that is mutative.
In the effort to facilitate the development of psychoanalysis as a science there has been a tendency among theoreticians to develop models that emphasize differences in interpretive strategies. This perspective has implicitly suggested that more accurate interpretation would yield better results. Yet analysts have always noted the importance of the personality of the analyst in the selection of analysts to treat particularly “difficult” patients and members of their families, as well as in selection of candidates for analytic training. This factor may be particularly important in working with certain traumatized analysands.
The analytic and therapeutic situations are in and of themselves research experiences. However, additional research perspectives that study process can help clarify the questions raised in this book. It would be interesting to attempt to study the influence of the analyst's personality in general and his available countertransference fantasies in particular on the process. It would be interesting to compare processes of a number of analysts working from a variety of theoretical perspectives that espouse different definitions of trauma and different conceptions of the mode or models of therapeutic action in the reconstruction of trauma.
In addition, future scientific meetings will contribute to the clarification of some of the questions raised in the book. The 1986 Workshop for Mental Health Professionals on “The Mode of Therapeutic Action of Psychoanalytic Psychotherapy or How Does Treatment Help?” should be of particular value in this regard. (pp. 229-230).
The workshops are held the weekend before Thanksgiving in New York City. In response to the success of past meetings, the Executive Committee decided to present a “second edition” of the annual workshop the following March in a different section of the country. These “second editions”, organized with the same panelists, but enlivened by new chairpeople and formal discussants, have created yet a further deepening of the discussions and have enriched the resulting monographs.
Monograph Three of The Workshop Series, The Interpretation of Dreams in Clinical Work, in preparation, will reflect these developments.
This year's second edition of “On the Role of Therapeutic Action or Psychoanalytic Psychotherapy or How Does Treatment Help?” was held in New Orleans on March 14-15, 1987. Future workshops will explore the questions of “The Relevance of Infant Observational Research for Clinical Work with Children,
Adolescents and Adults, (second edition to be planned for Seattle on March 12-13, 1988), and “The Significance of Child and Adolescent Analysis for Clinical Work with Adults” (second edition to be planned for a midwestern city in March of 1989).
These workshops may result in future monographs of The Workshop Series.
In ending this brief note, I am profoundly aware that although the workshops are a solidly established component of the Association's scientific activities, it is worth remembering those colleagues whose initiative and facilitating support contributed fundamentally to this current reality: Arnold Cooper, David Werman, Melvin Scharfman, Evelyne Schwauber, Sydney Pulver, Richard Isay, Morton Reiser, Ed Joseph, Paul Dewald and Richard Simons.