Idea Transcript
PSYCHOTHERAPY OF PREOEDIPAL CONDITIONS
PSYCHOTHERAPY OF PREOEDIPAL CONDITIONS
Schizophrenia and Severe Character Disorders by Hyman Spotnitz, M.D., Med. Sc.D.
A JASON ARONSON BOOK ROWMAN & LITTLEFIELD PUBLISHERS, INC. Lanham • Boulder • New York • Toronto • Oxford
THE MASTER WORK SERIES A JASON ARONSON BOOK
ROWMAN & LITTLEFIELD PUBLISHERS, INC. Published in the United States of America by Rowman & Littlefield Publishers, Inc. A wholly owned subsidiary of The Rowman & Littlefield Publishing Group, Inc. 4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706 www.rowmanlittlefield.com P0Box317 Oxford OX29RU,UK Copyright@ 1987, 1976 by Jason Aronson Inc. First softcover edition 1995 First Rowman & Littlefield Edition 2004 All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher. British Library Cataloguing in Publication Information Available Library of Congress Cataloging-in-Publication Data
ISBN 1-56821-633-5 (paper) ISBN: 978-1-56821-633-1
Library of Congress Catalog Card Number: 75-37489 Printed in the United States of America
9"'The paper used in this publication meets the minimum requirements of American National Standard for Information Sciences-Permanence of Paper for Printed Library Materials, ANSIINISO Z39.48-1992.
Preface
This book spans more than a quarter of a century. Its contents blend papers that are now out of print and currently in demand with previously unpublished lectures or othe~ oral presentations and some of my most recent contributions to multi-authored books on issues in contemporary practice. All of the material has been reedited, some of the early reports have been extensively revised, and the book has been organized to reflect the evolution of contemporary individual and group approaches to patients w~th severe but psychologically reversible problems originating in the preoedipal phase of development. These include psychosomatic conditions, psychotic states, and character and behavior disorders that can be traced back to psychological disturbances during the first two years of life. The book focuses on two subjects with which I have been preoccupied since I began the private practice of psychoanalytic therapy in 1939. One is the treatment of schizophrenia and other preoedipal disorders; the other, analytic group psychotherapy, as applied for the same purpose. I was drawn into the latter area during the 1940s as consulting psychiatrist to the treatment agency where S. R. Slavson and his associates were intent on the systematic development of group procedures. The book is intended for psychiatrists, psychologists, psychiatric social workers, and members of the other behavioral sciences, or those preparing to enter these fields, who are interested in achieving significant results in the treatment of severe forms of emotional illness. Understanding of the many forces that serve to create the mature personality is essential in this difficult work; but this needs to be combined with knowledge of therapeutics if one
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PREFACE
wants to help individuals with crippling preoedipal problems achieve their potential in life. When students enter supervision,. their main interest is usually in filling the requirements for carrying on the practice of psychoanalytic therapy. Operating under the pressure for accreditation, they tend to forget what they learn. If they return to supervision later, they generally demonstrate more serious concern about treating patients more effectively. It has been my privilege to carry on a second round of supervision for students and colleagues already trained in classical psychoanalysis who solicit further guidance in their work with schizophrenic and other preoedipal patients. These supervisees, like practitioners who consult me when problems arise in their management of such patients, have shown much interest in tracing the evolution of the modern methods of treating them. Knowledge of the various stages in the development of the approaches I recommend has not only increased their security and comfort in working with these patients; it has also stimulated new and original contributions in the spirit of these approaches. In making the same knowledge available through this book, I hope to open up new perspectives in the treatment of the preoedipal disorders and to facilitate more consistently effective results in these cases. Six of the papers in this book were collaborative works, as indicated in the text. They are reprinted here with the permission of Mrs. Yonata Feldman, M.S. W., Mrs. Betty Gabriel, Philip Resnikoff, and the estate of Leo Nagelberg, Ph.D. I am pleased to acknowledge the cooperation of Julia Older Bazer in the presentation of the book. Her assistance encompassed the organization and editing of its contents and the revision of some of the chapters. HYMAN SPOTNITZ
Acknowledgments
For permission to reprint material to which they hold copyright, grateful acknowledgment is made to the following sources: Introduction: "My Philosophy of Psychotherapy." JOURNAL OF CONTEMPORARY PSYCHOTHERAPY, 1973 (6:43-48). Copyright, the Long Island Consultation Center, Forest Hills, N.Y. Chapter 2: Discussion of "Irrational Trends in Contemporary Psychotherapy" (E. K. Schwartz and A. Wolf). PSYCHOANALYSIS AND THE PSYCHOANALYTIC REVIEW, 1958 (45 (1-2): 74-78). Chapters 2, 4, and 9 reproduced by courtesy of the Editors and the Publisher, National Psychological Association for Psychoanalysis, New York, N.Y. Chapter 3: "Strengthening the Ego through the Release of FrustrationAggression." AMERICAN JOURNAL OF ORTHOPSYCHIATRY, 1958 (28:794-801). Chapters 3, 15, and 16; Copyright, the American Orthopsychiatric Association. Reproduced by permission. Chapter 4: ''The Maturational Interpretation." THE PSYCHOANALYTIC REVIEW, 1966 (53:490-495). Chapter 5: ':The Toxoid Response." REPORTS IN MEDICAL AND CLINICAL PSYCHOLOGY, Monograph No. 3, 1963. Chapters 5, 10, and 11: Copyright, Psychology Department, Stuyvesant Polyclinic, New York, N.Y. Chapter 6: "A Psychoanalytic View of Resistance in Groups." THE INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY, 1952 (2:3-9). Chapters 6, 21, 22, 23, 27, 28, 29, and 30: Copyright, American Group Psychotherapy Association, Inc.
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ACKNOWLEDGMENTS
Chapter 7: "Psychoanalytic Therapy of Aggression in Groups." CURRENT PSYCHIATRIC THERAPIES, 1968, Volume 8, edited by J. Masserman. Copyright, Grune & Stratton, Publishers, New York, N.Y. Chapter 8: "The Management and Mastery of Resistance in Group Psychotherapy". THE JOURNAL OF GROUP PSYCHOANALYSIS AND GROUP PROCESS (now GROUP PROCESS), 1968 (1(2] :5-23). Chapter 9: "The Myths of Narcissus." THE PSYCHOANALYTIC REVIEW, 1954(41:173-181). , Chapter 10: "The Narcissistic Defense .in Schizophrenia." REPORTS IN MEDICAL AND CLINICAL PSYCHOLOGY, Monograph No. 1, 1961. Chapter 11: "The Need for Insulation in the Schizophrenic Personality." REPORTS IN MEDICAL AND CLINICAL PSYCHOLOGY, Monograph No.3, 1963. Chapter 12: "Techniques for the Resolution of the Narcissistic Defense." PSYCHOANALYTIC TECHNIQUES: A Handbook for the Practicing Psychoanalyst, edited by B. B. Wolman. (C) 1967 by Basic Books, Inc. Publishers, New York. Chapter 13: "Group Psychotherapy with Schizophrenics." GROUP PROCESS TODAY: Evaluation and Perspective, edited by D. S. Milman and G. D. Goldman, 1974. Charles C Thomas, Publisher, Springfield, Ill. Chapter 14: "Initial Steps in the Analytic Therapy of Schizophrenia in Children." THE QUARTERLY JOURNAL OF CHILD BEHAVIOR, 1952 (4 :57-65). Chapters 14 and 20, Copyright, Jelliffe Trust. Chapter 15: "The Attempt at Healthy Insulation in the Withdrawn Child." AMERICAN JOURNAL OF ORTHOPSYCHIATRY, 1953 (23: 238251). Chapter 16: "Ego Reinforcement in the Schizophrenic Child." AMERICAN JOURNAL OF ORTHOPSYCHIATRY, 1956 (26: 146-162). Chapter 17: "Adolescence and Schizophrenia: Problems in Differentiation." ADOLESCENTS; Psychoanalytic Approach to Problems and Therapy, edited by S. Lorand and H. I. Schneer, 1961. Copyright, Medical Department, Harper & Row, Publishers, Inc., Hagerstown, Maryland. Chapter 18: "Object-Oriented Approaches to Severely Disturbed Adolescents." THE ADOLESCENT IN GROUP AND FAMILY THERAPY, edited by M. Sugar, 1975. Brunner/Mazel, Publishers, New York, N.Y. Chapter 19: "Observations on Emotional Currents in Interview Group Therapy with Adolescent Girls." JOURNAL OF NERVOUS AND MENTAL DISEASE, 1947 (105: 565-577). Copyright, Jelliffe Trust. Chapter 20. "Resistance in Analytic Group Therapy: A Study of the Group Therapeutic Process in Children and Mothers." THE QUARTERLY JOURNAL OF CHILD BEHAVIOR, 1950 (2: 71-85).
Acknowledgments
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Chapter 21: "The Borderline Schizophrenic in Group Psychotherapy." THE INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY, 1957 (7:155-174). Chapter 22: "The Concept of Goals in GrC?UP Psychotherapy." THE INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY, 1960 (10: 383-393). Chapter 23: ''Touch Countertransference in Group Psychotherapy." THE INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY, 1972 (22:455-463). Chapter 24: "Acting Out in Group Psychotherapy." GROUP THERAPY 1973: An Overview, edited by L. R. Wolberg and E. I