Transforming Aggression: Psychotherapy with the Difficult-to-Treat Patient

282 Pages·2001·13.83 MB·English

by  Frank M. Lachmann

Transforming Aggression
Psychotherapy with the
Difficult-to-Treat Patient
Frank M. Lachmann, Ph.D.
A JASON ARONSON BOOK
ROWMAN & LITTLEFIELD PUBLISHERS, INC.
Lanham • Boulder • New York • Toronto • Plymouth, UK
A JASON ARONSON BOOK
ROWMAN & LITTLEFIELD PUBLISHERS, INC.
Published in the United States of America
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Copyright © 2000 by Jason Aronson Inc.
First Rowman & Littlefield edition 2008
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British Library Cataloguing in Publication Information Available
Library of Congress Cataloging-in-Publication Data
Lachmann, Frank M.
Transforming aggression : psychotherapy with the difficult-to-treat patient. I
Frank M. Lachmann.
p. em.
Includes bibliographical references and index.
ISBN-13: 978-0-7657-0293-7
ISBN-10: 0-7657-0293-2
I. Aggressiveness. 2. Psychotherapy. I. Title.
[DNLM: I. Psychotherapy. 2. Aggression-psychology. WM 420 LI38t 2001]
RC569.5.A34L33 2001
6.6.89'14-dc21 00-038963
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, ANSI/NISO Z39.48-1992.
To Annette, Suzanne, and Peter

Contents
Preface vii
Acknowledgments
XV
1. Self Psychology Strikes Back 1
2. The Aggressive Toddler and the Angry Adult 25
3. The View from Motivational Systems Theory 47
4. State Transformations in Psychoanalytic Treatment 73
5. State Transformations and Trauma 87
6. State Transformations through Creativity 103
7. The Transformation of Reactive Aggression
into Eruptive Aggression 119
8. It's Better to Be Feared Than Pitied 149
9. The Empathy That Enrages 173
10. A Requiem for Countertransference 191
11. A Systems View 209
12. Self Psychology and the Varieties of Aggression 221
References 239
Credits 255
Index 257

Preface
Coming of age as a psychologist in the field of psycho
analysis just before its domination by the medical establishment declined
presented an extraordinary challenge: how to get training in psycho
therapy and psychoanalysis when many doors to analytic training were
closed to nonmedical candidates. Among the reasons for this exclusion
was the belief that psychoanalysis required a knowledge of medicine.
My graduate school education had emphasized psychological test
ing and research, but my fellow intern at Bellevue Hospital, Lloyd
Silverman, whetted my interest in psychoanalytic theory. I was able to
find psychotherapy training in the mid-l950s at a Veterans Administra
tion outpatient clinic. Later, at the Postgraduate Center for Mental Health
in New York, my training broadened to include psychoanalysis.
In those years, by training and temperament, I was an ego psy
chologist. Even then, as a psychologist, psychotherapist, and psycho
analyst, I was part of a distinct, still restricted minority. Likening this
experience to having grown up as a jew in Germany in the 1930s is a
stretch, but being part of a discriminated-against minority was not unfa
miliar to me. So, my reaction of frustration at being a psychologist when
Vlll PREFACE
the practice of psychotherapy and psychoanalysis was open mainly to
physicians is perhaps one, among my several motives, for writing a book
on "reactive" aggression.
In the 1960s I became acquainted with the work of Heinz Kohut in
a seminar on the development of psychoanalytic thought taught by Mar
tin Bergmann, the consummate teacher, scholar, and practitioner of psy
choanalysis. In the years I spent in one of his study groups I became
acquainted with the vast and exciting literature of psychoanalysis.
I liked Kohut's challenge to the prevailing clinical and theoretical
wisdom of psychoanalysis. In his early papers, I found a blueprint for a
truly widening scope for psychoanalytic treatment. The attacks on Kohuts
work by the psychoanalytic establishment that followed his writing for
the next several years surprised and outraged me. Here, I believe, arose
another motive for writing about aggression from the vantage point of
Kohuts contributions.
In the 1980s, after Bob Stolorow and I had published Psychoanaly
sis of Developmental Arrests, I was invited to become a member of the
Program and Publications Committee, the forerunner of the Interna
tional Council for Psychoanalytic Self Psychology. Thereby my partici
pation in the development of self psychology was assured, and, ironi
cally, I became an even more active and committed member of an out
of-favor minority.
In the past two decades I have been struck by the combination of
half-truths as well as by the valid questions that have characterized the
criticism of self psychology in the psychoanalytic literature, case confer
ences, and especially in the meeting rooms and corridors at psychoana
lytic conferences. The voices of relational psychoanalysis joined the chorus
of classical Freudian analysts in looking askance at the theory of self
psychology, and especially the clinical implications that grew out of the
theory. Furthermore, relational analysts, whose ranks have swelled dur
ing the past decade, have been more radical than their classical analytic
counterparts. They have advocated, if not actually "throwing away the
book," then deconstructing it, at least in the postmodem sense. Once
again, I find myself swimming against the current. In my desire to main
tain some continuity with the past, I am not prepared to join that chorus
either.
PREFACE ix
Perhaps I am still clinging to a minority status. However, as I see it,
I am primarily interested in the leading edge of theories rather than in
examining them from a trailing-edge perspective. I have borrowed these
edge terms from Heinz Kohut's view of interpretation. In making inter
pretations, Kohut advised, the leading edge addresses what the person is
striving to achieve, and the trailing edge addresses the contents and con
flicts that are avoided, repressed, or disavowed. Both edges are impor
tant in psychoanalytic treatment and in theory evaluation. But life among
the trailing edges can be grim, whereas the leading edge carries hope
and points to a direction for the future. In the course of this book I
articulate the leading edge of self psychology in psychoanalytic treat
ment. To be able to do so provides me with another motive for writing
this book. Contrary to the assumptions of its detractors, trailing-edge
interpretations are not avoided in self psychology, but neither are they
privileged.
A friend asked me if it had been difficult for me to switch to self
psychology from my classical psychoanalytic beginnings. My friend re
membered that I had taught the contributions of Arlow, Brenner,
Greenson, and jacobson, and the work of many other ego psychologists
at the Postgraduate Center for Mental Health in New York. In respond
ing, it struck me how easy that shift had been for me. In truth, I had
been practicing as a self psychologist all along. I found in self psychol
ogy the framework that fit the way I had already been working in my
practice.
The conservative in me has held on to aspects of the conflict model
that I found useful as an ego psychologist. However, 1 think of conflict
as a subjective experience that captures what a person is struggling to
express, suppress, disavow, or attribute to others. I am not referring to
conflict as the theoretical assumption that explains motivations and leads
to compromise formations. The question of drives, what is innate, espe
cially when it comes to aggression and destructiveness, is another mat
ter and that will occupy the pages to follow.
Self psychology places its emphasis on individual uniqueness and
on the uncanny resourcefulness and survival strivings of people. I like
Kohuts focus on self-experience, thereby giving these strivings and re
sources a legitimate theoretical and clinical status. So I consider myself a