HOME     Biography     Private Practice     Groups    Workshops/ Seminars    Object Relations Approach  

 Articles    Books   Argentine Tango     Pictures/Video/Media    Links     Contact us 

American Psychological AssociationPsychoanalysis (Division 39)


The Creative Mystique: From Red Shoes Frenzy to Love and Creativity (Book Review)

Author:Kavaler-Adler, Susan
Publisher: New York: Brunner-Routledge, 1996
Reviewed By: Frank Summers, Winter 2002, pp. 50-56

Interview With Susan Kavaler-Adler
Dr. Susan Kavaler-Adler is the author of three books and 40 articles related to her view of mourning as a developmental process (“developmental mourning”) that is fundamental to self integration as well as to psychic change and transformation throughout one’s lifetime. Her unique integration of British and American object relations theory can be seen throughout her writing, fully defined as a theoretical perspective related to “developmental mourning” in her first book The Compulsion to Create: Women Writers and Their Demon Lovers (Routledge, 1993, Other Press, 2000). Dr. Kavaler-Adler’s focus on a well-known brilliant women writers in this book and on brilliant women writers and artists in her second book, The Creative Mystique: From Red Shoes Frenzy to Love and Creativity (Routledge, 1996) allows her to explore how the creative process can be the focus of progressive mourning for self integration and reparation or can be the captive of a demon lover complex (an object relations view of pathological mourning and psychic arrest) in those that fail to mourn due to developmental arrest from trauma in the primal stage of self development.

Dr. Kavaler-Adler’s third book, in press with Routledge, goes deeper into the clinical area than these two books, while further elaborating her theoretical perspective, in relation to Freud and the British theorists. This book, Mourning, Spirituality, and Psychic Change: A New Object Relations View of Psychoanalysis, extends the clinical application of Dr. Kavaler-Adler’s theories that can be seen in her first two books with in-depth descriptions of the developmental mourning process in dialectic with transference work in analysis, and with the interactive engagement of the psychoanalyst and analysand. The following interview focuses primarily on the thesis of the first two books, but touches on the third book at the end.

Dr. Summers: What would you say is the primary message of your work?

Dr. Kavaler-Adler: The primary focus of my work is on the use of the psychoanalytic situation to promote a developmental mourning process that allows self integration, self differentiation, separation-individuation and the growth of capacities for both love and creativity to take place. In my first two books I focus on women artists and writers who attempted to use the creative process for psychic development and for psychic reparation and healing. I found that these brilliant and well-known women often failed in their attempt to use the creative process for psychological purposes without undergoing an adequate clinical treatment. Curious to understand why, I used the extensive research I did on the biographies and creative work of these women to describe the repetition of primal trauma as it appears in the work and lives of these women as a demon lover complex. This demon lover complex appears in themes of muse-god figures who continually turn demonic when the woman artist seeks merger with them through their self-expression in creative work. In a creative moment of ecstasy, Emily Bronte yearns to merge with a vague male phenomenon, who in her fantasy is the muse inspiring her creativity and her life as she attempts to live life within her creative work. The female poet cries: “My outer sense is gone. My inner essence feels!” Expecting to be rescued from the pain involved in living within a traumatized body by the deified fantasy muse, she surrenders to an ecstatic state of bliss, only to be rudely and abruptly dropped into the hell of submission to a masculinized other to whom she has offered up all her power, as it exists in a state of manic erotic desire and craving. The poem turns from merger with an inspiring muse to the possession of the male that extinguishes the independent voice of the female poet. The next image of the poem is of a tombstone in a cemetery. Transcendence has failed and possession results, when the woman displaces all her own potential power into the fantasy figure of the male muse-god through projective-identification.

Her compulsion to do so stems back to her own traumatic self-disruption during the toddler years of separation-individuation. The repetition brings loss of voice, and thus of life, for the female poet. The demon lover theme is complete in a continuing cycle that creates the demon lover complex, (as seen throughout the work and life of a multitude of women), when the yearning to merge with an omnipotent fantasy god results in possession and/or abandonment leading to the ultimate denouement of death. This is a death at the hands of the demon lover, who is a projected combination of mother and father part object internalizations, along with the split off aggression and eroticism that cannot yet be tolerated at the level of psychic fantasy, unless expelled onto paper or canvas. The woman’s failure to mourn the early trauma results in this object relations phenomena of a psychically fixed pathological mourning state.

Women artists, just like other women, need a psychoanalytic/object relations treatment to recover from the psychic arrest that can feel like an endless paralysis in creativity and in life, when loving relationships continually fail. Yet, the very artists and writers who are so affected may reject clinical treatment due to certain societal and cultural myths. I deconstruct two of these myths in The Compulsion to Create. The first is that you have to be crazy or depressed to profoundly create. The second is that you cannot enter psychotherapeutic treatment because you need to preserve your psychopathology in order to be crazy or depressed to create. In truth, a clinical process that includes the developmental mourning of abandonment depression trauma will be the primary route to an enhanced creativity. Treatment can allow the artist’s creativity to be finally liberated from its compulsive and diminishing repetition, as mourning heals the splits and dissociations due to the trauma and allows the artist to understand her primal dilemma so that she can create a life in the world that can nourish both her and her work.

Dr. Summers: How do you think people use the creative process?

Dr. Kavaler-Adler: How people use the creative process depends on their developmental issues (desires, conflicts, and traumas). For women with early trauma, during the first three years of life, when the self is first being formed, their basic psychic development is disrupted in a critical way. These traumatized souls are driven to create to externalize an internal division within the self that they are unconsciously trying to repair. They often create in a state of manic intensity, which is reflected in their creative process and in the characters in the content of their work. They often attach to the creative process itself as if it’s the early mother.

If these individuals cannot consciously face and mourn their early trauma, they repeat it continuously, both in their life and in their work. Those most traumatized often try to give up their external life altogether and to live within the virtual world of their creative work and creative process (Emily Bronte, Emily Dickinson). On the pages of their work they endlessly live out their hope for love and life and the failure of this hope. Emily Dickinson describes the demon lover parent/god who possessed, abused, and abandoned her in her fantasy as “the metallic god who drilled his welcome in,” and the deity who “lets loose one thunderbolt” that “scalps [her] naked soul.” Like any addiction, such absorption in sadomasochistic fantasy takes over and destroys life. The woman artist seeks an unavailable, idealized man within the fantasy realm of her work in a futile effort to repair the disrupted self.

By contrast, I have found that women artists who have had good enough development in their first three years of life are able to mourn and repair themselves through their own creative work, independent of clinical treatment. At least to a certain extent they can tolerate the grief of mourning in their work, since the aggression related to it is less primitive and disruptive to their symbolic capacities than it is for those traumatized. They can succeed at symbolizing the figures whom they need to separate from, since they are equipped with whole object attachment in their internal worlds. Through their symbolic capacities, they are able to mourn losses that are often at the level of Oedipal disillusionment where separate rather than merged objects are found. Also, they suffer the pain of love that involves differentiated male figures of human rather than god-like or monster-like proportions. Two such women artists are Charlotte Bronte studied in The Compulsion to Create and Suzanne Farrell of the New York City Ballet studied in The Creative Mystique, who had Ballanchine as a masculine muse whom she does not convert to a demon.

Those who do not internalize an early holding environment cannot mourn. For example, Anne Sexton tried, but couldn’t mourn properly. Although she was creative and highly productive, her creativity was not able to contain, symbolize and thus help her mourn her early trauma. Even though she sought therapeutic treatment, the lack of understanding of the borderline personality and of object relations work on the part of one legitimate clinician caused the failure of treatment and caused exacerbating countertransference enactments. In the second treatment, Anne Sexton succeeded at enacting a masochistic submission to a male psychiatrist who enacted the role of the demon lover, heralding the Greek tragedy of her eventual suicidal demise, as she repelled the husband who loved her. Two chapters on Anne Sexton in The Creative Mystique go into careful detail of the failed clinical attempts and the abuse in the clinical situation that replayed the demon lover cycle.

Dr. Summers: How do you see mourning as a developmental process?

Dr. Kavaler-Adler: Mourning helps the child go through the separation-individuation process and to thus achieve self-integrity. The child needs to let go of the primal parents and life long mourning may be involved, but critical separation-individuation stage mourning is essential. The more pathological the parenting and the more disrupted the early maternal bonding the harder it will be to let go, because then no adequate internalizations will be formed to create an inner blueprint for new and future relationships to be created. If mourning does not take place, development is arrested.

Dr. Summers: What do you see as happening when the child gives up his/her dependence on the parent?

Dr. Kavaler-Adler: If adequate internalization has taken place, the child develops capacities for many forms of psychic dialectic that are the core of psychic health. In The Creative Mystique I speak of psychic health in terms of a “love-creativity dialectic,” which is a free flowing interchange between connection to one’s internal world for the expression of creative work and the connection to others through the intimacy of interpersonal relations in the external world. This psychic dialectic operates in parallel with dialectics between mind and body, and between personal voice and other directed empathy, as well as other psychic dialectics, as spoken about in the work of Sheldon Bach. When one form of dialectic is arrested by splitting so are the other forms of psychic dialectic. When someone deflects a whole part of themselves into the other through projective-identification, rather than interacting with or being with the present other, this is a sign of failed dialectic due to pathological splitting from early trauma.

However, if there has been enough sustained affect contact between the parent and child during the formative stages of self-development, a dialectic between self and object takes place that becomes internalized. This dialectic takes place internally between the self and the lost other represented in the internal world during the mourning process. If no blueprint for self and other relating has been established the internal dialectic needed for mourning cannot take place. Without the dialectic of mourning, there is no renewal of love for a potential new object, and creativity is arrested as love is arrested. The psychic dialectic is needed for both love and creativity, and the dialectic of mourning is needed for both to be re-born when the shock of object loss threatens to abort the flow of internal process. If there has not been enough relating between parent and child, this developmental process is disrupted, and all the other dialectics of healing and of living are never established.

Dr. Summers: And then?

Dr. Kavaler-Adler: The early trauma leads to a build-up of more bad than good internal objects, leading to an excess of sadomasochism. Then there is not enough psychic space for the pathological internalized objects, and they cannot be contained. The result is an abandonment depression (Masterson) related trauma. In this situation, the child cannot mourn. She needs therapy to develop the capacity to mourn the early loss of objects. Charlotte Bronte did mourn on her own through the character Lucy Snowe, in her last novel, Villette, which is her most profound psychological novel, despite the more action paced and magical Jane Eyre. In reading many biographies of Charlotte Bronte, I discovered that Charlotte Bronte was able to transform her loss by going through her own grieving process because she had internalized a good enough mother. Therefore, she went through her grieving at the Oedipal level, and her creativity helped her to do it.

People can mourn on their own if they have a sufficiently internalized relatedness with their early mother, a mother who can register in the internal world as a good enough figure, becoming a whole object representation rather than a viscerally intrusive and disruptive internal object. When the Bronte sisters’ mother got ill with cancer her younger daughter Emily was two and two and a half, in the critical stages of separation-individuation. When the mother died Emily was three. Her sister Charlotte was already five and had much more sustained nurturance from a healthy mother, and was already moving into the realm of attachment with the Oedipal father. Emily Bronte, unlike her sister, Charlotte, became schizoid, and like Emily Dickinson, who also became schizoid, she secluded herself in her father’s home for life, until dying from illness in her thirties, turning her father’s home into a maternal womb, resisting ever leaving it. Emily Bronte tried to overcome the loss of her mother by idealizing her father and then seeking his fantasy equivalent, a male muse phantom, energized by internal object enactments. Emily’s muse inevitably turned demonic being eroticized by Emily as she sought the body merger of an infant overwhelmed with Oedipal level drive energies. Emily’s muse became her demon lover; just as her did Heathcliff become the demon lover for her alter-ego heroine, Catherine, in Wuthering Heights.

Lacking a sold sense of self, Emily Bronte sought self-agency through creating male characters in her work and then attempting to merge with them. The idealized masculine figure became the target of early cravings for her mother (expressed repeatedly in oral and anal terms). The muse mother/father figure, once eroticized and endowed with split off aggression, becomes the demon lover who lives upon the stage of the creative work, which becomes too exactly a replica of the internal world, rather than its evolving transformation as it was for Emily’s older sister, Charlotte. Virginia Woolf, Diane Arbus, Sylvia Plath, Camille Claudel, Anna O., Katherine Mansfield and Edith Sitwell are other examples of those who I have written who also operate in this desperate enactment within their creative work, as did Emily Bronte and Emily Dickinson. However, in the clinical cases at the end of the books I demonstrate how object relations psychoanalytic psychotherapy can heal the very splits created in such personalities. This is true when these personalities are able to mourn and find the meaning of the psychic fantasies attached to their extreme opposite self-states within the holding environment of treatment.

Dr. Summers: All of this raises a question for me: How do you know whether the trauma suffered was Oedipal or pre-Oedipal?

Dr. Kavaler-Adler: This can be determined from their biographies. Emily Bronte lost her mother when she was two and three, but her sister was five when her mother first got ill. Charlotte’s major loss was the disillusionment with her father. Emily’s internal loss led to the longing for an attachment to a male figure and led to her Demon Love Complex. Emily Dickinson has pathological story of her own. Dickinson had a mother who was a schizoid personality to begin with, and then was in a profound pathological mourning state when she lost several close family members just prior to the birth of her daughter, Emily. In each case, one can see the roots of the trauma in the maternal relationship and the dynamic picture.

Dr. Summers: Is there a problem here in your assuming a pre-Oedipal conflict in those women who are unable to resolve their conflicts and assuming an Oedipal conflict in those who can resolve their conflicts? Could there be circularity here?

Dr. Kavaler-Adler: There’s nothing circular about it at all. When I began my studies of women writers and artists I was expecting one thing and I found the other, through a careful review of the biographies and the creative work of the subjects of my study. I was hoping to find the positive capacities of the creative process as a format for the developmental mourning process, and instead I found that in the case of most of the writers and artists whom I studied, who tended to have profound fantasy systems around male fathers or male authority figures, there was evidence of early pre-Oedipal trauma that went hand in hand with arrests in mourning process within creative work and with the compulsive nature of the creativity, in contrast to those with free creative motivation (and love-creativity dialectic) who could mourn and self integrate through their creative work.

The female sculptor, Camille Claudel is a case in point. Her biography demonstrates how a cold and paranoid mother, along with a narcissistic father, who treated her as special due to her artistic talent, resulted in her living out a demon lover complex with the male sculptor Auguste Rodin. In the throes of disappointment with Rodin, from whom Claudel sought the love lacking with her mother and the role of a special child that she had with her father, Claudel smashed her sculptures, became suicidal and became profoundly paranoid about Rodin. After she broke up with Rodin as a lover and turned her story into that of him abandoning her (he did resist marrying her), Claudel viewed Rodin, as a malicious rival who was calculating day and night to steal her work and to impoverish her. In fact, Rodin attempted to support Camille as an artist, although he also co-opted some of her art. Perhaps Rodin envied Claudel’s talent, which he thought to be greater than his own. Far beyond any reality, Claudel developed a whole paranoid system around Rodin to avoid facing the hate and abandonment she felt in relation to her mother. Yet it was her mother who incarcerated Claudel in a mental hospital and refused to have her released, so that she died there after rotting away for thirty years.

This case demonstrates that Kohut was wrong when he assumed that a father’s attention and idealization could substitute for the failed early mother’s love. Claudel’s search for a father became an addiction and a compulsion to create, as opposed to a free motivation to do so. Her creative process became a captive of her psychodynamics. Her Oedipal issues were clearly overshadowed by the pre-Oedipal ones. Her attempt to mourn through the grief stricken figures that she portrayed in her artwork clearly failed, as she smashed the very sculptures she created in a ritual attack on the male father-god figures, father and Rodin, who had encouraged her to be an artist. Her attacks on the father muse gods through her attacks on her own sculpture express the level of hate that she had to dissociate in relation to her primal mother in order to psychically survive. Yet her attempts at psychic survival were tenuous and she ultimately succumbed to withdrawal from the world and to psychic death, a purgatory of deadness that lasted thirty years before her actual physical death.

Dr. Summers: Is there any difference between such a compulsion and the use of drugs or alcohol?

Dr. Kavaler-Adler: The “compulsion to create” is often accompanied by alcoholism and/or drug addiction, as in the cases of Camille Claudel and Anne Sexton. There is a similarity between addiction to a substance and to a creative process that is unconsciously representing the lost symbiotic mother of infancy, prior to the disruption of maternal bonding. Without an adequate mother of during the separation-individuation period there is no development of psychic dialectic because there is no internalized blue print of self and other in relationship to each other through states of both connection and autonomy. Without this psychic dialectic that becomes love-creativity dialectic and the dialectic between self and other in both the internal and external worlds, compulsion or blocking occurs in creative process and in life process. Such compulsion and/or blocking results in failure in the critical process of developmental change seen in mourning and grief. Only when aggressive states can be contained, modified and symbolized can mourning proceed so that new modes of developmentally advanced connection can proceed. Without such containment, modification and symbolization of aggressive states the internal aggression blocks the flow of thought and feeling that becomes creative process and psychoanalytic process. In other words, the unassimilated aggression, like Wilfred Bion’s beta elements, drives one into manic thrusts of compulsion.

Dr. Summers: And without creativity?

Dr. Kavaler-Adler: An addiction is inevitable.

Dr. Summers: And how does this fit with what you call “the creative mystique”?

Dr. Kavaler-Adler: The “creative mystique” is an addiction to one’s own image as an artist versus just being in the process of creating. For example, Edith Sitwell became manic in order to keep up the mystique of feeling recognized. She was desperate for a basic recognition that she could never get from an absent and disorganized borderline mother and a grossly grandiose narcissistic and schizoid father. She frantically sought this recognition by performing her poetic works, striving to feel wanted by the audience, an audience that she later attacked and devalued. Sitwell was desperate to create an idealized image of her as she performed, and this manic activity warded off the primal object loss of early trauma that was terrified of confronting. Creating her image through her art, seeking to be a “star” as an artist was her mystique. When Sitwell got too old to perform, she withdrew to her bed and compulsively drank a milk-laced brandy. Angry with an audience that couldn’t repair her, she stopped writing poetry, the one thing that had kept her going. Earlier when she had gotten close to her actual pain in her poetry, and had used the word mourning, and seen visions of a wounded and emaciated child self within her, she quickly aborted the process and stopped writing poetry for ten years. When she returned to writing poetry she placed herself above a devalued feminine child self in the role of a prophet, who looked down on the female masochistic self and the demon lover male figure to which it was always attached (like Fairbairn’s sealed-off libidinal and anti-libidinal egos). She used a manic psychic defense to go on compulsively writing, without the expression of the true self.

Dr. Summers: Is there a cultural aspect to this?

Dr. Kavaler-Adler: It started with the romantic poets: Keats, Shelley, Wordsworth, and Blake. These were great poets, but their followers tended to idealize the image of being an artist. This resulted in the cult of suicide and death that followed Sylvia Plath, Anne Sexton, and Diane Arbus, when the image of the artist was extended to the idealization of the artists who committed suicide.

Dr. Summers: Your work focuses on women, but is the process any different for men?

Dr. Kavaler-Adler: No. Van Gogh would be a good example. He was in a state of manic excitement on the day when he shot himself and continued at the same time to paint his last painting.

Dr. Summers: Do you see Van Gogh as dealing with the same issues as the women you’ve studied?

Dr. Kavaler-Adler: Yes. Van Gogh had a frantic need to express something from within, a need that was so intense because of his craving for the mothering he never had. He was searching for a mother’s basic recognition as well as for an authentic self, in the midst of his internal self being sealed off and divided from the world of external relations. The basic issues are the same for men and women artists, but they are dealt with differently. The male artist seeks a muse that is an externalization of a grandiose self, hoping to be inspired by this split off grandiose self. He feels that he receives inspiration and thus power, from his muse, which is often female. The developmentally arrested female artist often seeks a muse that turns against her, possessing her rather than inspiring her. By worshipping a muse god that turns demonic, and which enacts upon her a masculine form of domination that extends to sadism, she creates a masochistic position for herself. In this way, the arrested female artist re-experiences the helplessness of an infant dependent on an inadequate and unavailable mother.

Dr. Summers: How do we understand dynamically the difference between the male and female artist?

Dr. Kavaler-Adler: That’s a good question. For the man the mother is both the pre-Oedipal and Oedipal object. The boy feels a sense of power, and when he losses the mother he continues to seek an inspiration for his power. The little girl switches from the mother as pre-Oedipal object to the father as the Oedipal figure. Through the Oedipal longing, the female may seek a power she cannot have. If the father relationship is insufficient, the girl continues to seek the power that she feels resides in the male. She masculinizes and eroticizes the object of her primal cravings that stem back to her need for her mother.

Dr. Summers: It sounds like there is similarity here with the work of Jessica Benjamin.

Dr. Kavaler-Adler: There is an overlap. Benjamin speaks of the omnipotent angel figure and I speak of the muse/demon. We both touch on the archetypical dimensions of the primal infant yearnings that can become pathological in the developmentally arrested adult. Benjamin speaks of the lack of a symbolic third, and I speak of the lack of symbolism in those for whom separation-individuation has not taken place due to the lack of capacity to mourn. The failure to mourn I speak of involves the lack of the father as a differentiated third figure, as opposed to the father as an alternate mother or extension of mother Differentiation fails along with the failure of mourning. For Benjamin the female child can be consumed and engulfed by the tie to the mother when the father isn’t there to serve as a differentiated figure for identification, aside from his role as an Oedipal love object. However, in my work I emphasize that the father can never be perceived as differentiated, no matter how differentiated he is as an objective figure, unless developmental mourning has proceeded and allowed separation-individuation to take |place. All of this depends on the personality of the primal mother, and her capacity to negotiate the complex interplay of closeness and distance involved in the separation-individuation phases of development..

Dr. Summers: How does the male artist evade mourning?

Dr. Kavaler-Adler: When the parents are inadequate narcissistic compensation may be sought in the male through idealizing the father figure and then identifying with his own contrived image of omnipotence. Simultaneously, he devalued the underdeveloped child and infant self, seen as an inferior feminine self that is split off and projected into women. To defend against his impotent feelings, a boy can split of his feminine side and project it into females, so that his muse figures become part object self extensions, who have the air of devalued female cherubs. Thus, the male remains underdeveloped, and without re-owning his split off feminine side the work of mourning can never proceed. Consequently, the self remains in a manic state of narcissistic defense and lack of completion.

Dr. Summers: What do you feel the relevance of this is for clinical work?

Dr. Kavaler-Adler: What is needed developmentally is mourning and integration. What gets in the way in a pathological mourning state is the Demon Lover Complex, and this is what comes up with patients.

Dr. Summers: What is needed to mourn?

Dr. Kavaler-Adler: What’s needed is to symbolize and process affects related to loss, including aggression as well as grief. When that happens, the patient can internalize a containing internal object that creates a containing sense of self. The patient needs to do this with the therapist. If that occurs the patient replaces mourning with going-on-being, and becomes truly capable of being present with the self and with the internal or external other in the moment. From this stems all love and creativity.

Dr. Summers: And you believe that at the Oedipal level the patient can use creativity to mourn?

Dr. Kavaler-Adler: Yes. There is convincing evidence of this. Creativity can be used as the mourning process, and the person then can continue to be creative, as mourning also promotes the discovery of creativity within the self. Creativity is gained, not lost, is the person is healthy.

Dr. Summers: Can you say something about your new book, Mourning, Spirituality, and Psychic Change: A New Object Relations View of Psychoanalysis?

Dr. Kavaler-Adler: Mourning has been both implicit as well as explicit in psychoanalytic theory, stemming back to Freud’s Mourning and Melancholia. In Klein’s Mourning and Its Relation to Manic Depressive State, Klein first speaks of mourning as a critical clinical and developmental process. I have continued from Klein and have shown how Winnicott, Fairbairn, Balint and Bowlby are all dealing with mourning as well.

Winnicott’s ideas on object survival through the continuing presence of the analyst during the primitive rage affect storms of developmentally arrested patients, and survival through the relinquishing of interpretation when it is being experienced as retaliation, are all related to a dialectic with Klein that opens the pathway to grief and mourning, and to the free associative and symbolic processes that are a part of this mourning. Fairbairn’s whole theory of the addiction to a bad object is about a pathological mourning state and thus speaks implicitly to the theory of mourning. Since mourning requires that the subject experience more love than hate for the object, the possession by a primal bad object, related to the original real external object, obviously obviates mourning. Balint speaks explicitly of mourning in speaking of healing the basic fault. Bowlby, a follower and analysand of Klein, speaks of mourning as a fundamental developmental process in which aggression has an accepted role, rather than being seen as defensive as Klein would view it. In my new book I relate to all these theories in my discussion of mourning and psychic change and in my discussion of my own metapsychology. I am in dialogue with these theorists who are in dialogue with each other. However, I also add the element of spirituality to the mourning process, since it appears so vividly in some of my in-depth clinical cases. It has been reported recently that only three out of a thousand articles on psychoanalysis address spirituality. I wrote the case studies in this book some time ago and can now look back at the profound psychological change that emerged, as I remained attuned to the spiritual dimensions of the developmental mourning process. This is true whether these dimensions emerged directly in the clinical dialogue and the clinical associations, or they emerged in the art and dreams of the analysands.

Dr. Summers: That’s all the time we have to talk.

Dr. Kavaler-Adler: Thank you. It’s been a pleasure sharing my work and ideas with you.



Transcending the Self (Book Review)

Author: Summers, Frank
Publisher: Hillsdale: NJ: The Analytic Press, 1999
Reviewed By: Susan Kavaler-Adler, Fall 2001, pp. 37-43

An Interview with Frank Summers

Frank Summers has brought object relations theory into a crystallized clinical focus in his two books: Object Relations Theory and Psychopathology (Analytic Press, 1994) and Transcending the Self (Analytic Press, 1999). In Object Relations Theory and Psychopathology, Dr. Summers defined his integration of object relations thinking by defining, critiquing, and contrasting an impressive array of psychoanalytic theories. Dr. Summers has an appreciation for each theory, but is clear in his view of each theory’s shortcomings when applied to clinical work. In line with his deep conviction that theory is only useful if it helps people receive psychotherapeutic treatment that resolves developmental arrests and promotes psychic change towards authentic self development, Dr. Summers approaches his discussions of strengths and weaknesses of each psychoanalytic theory in its clinical application. In doing so, he highlights contrasts between ego psychology and object relations theory, between relational theory and object relations theory, and between self psychology and object relations theory. These contrasts lead to his own formulation of theory at the end of Object Relations Theory and Psychopathology, which becomes the entry to his second book. Transcending the Self has rich clinical illustrations of an evolving theory. In the following interview, part of a mutual interview between Dr. Summers and myself, I engage Dr. Summers as an author to explicate both his metapsychology and his clinical theory.

Dr. Kavaler-Adler: Dr. Summers, in both your books you discuss an object relations approach to helping patients relinquish pathological self and object constellations with the internal world so as to move developmentally forward into more mutual modes of relating that can encourage self development through new modes of internalization. Is there an underlying philosophy of psychic health that lies behind your clinical theory?

Dr. Summers: The concept is Nietzschean: we must become who we are. I believe that the extent to which we experience meaning and fulfillment comes from how well we realize the potential self. I think Winnicott gave us the germ of a useful psychoanalytic concept of psychic health: the development of inborn potential in all its aspects. The extent to which our authentic feelings and capacities become articulated in our ways of being and relating is the degree of our mental health. When our potential self is arrested, we will find some means of expressing it, and such veiled expression are symptoms.

Dr. Kavaler-Adler: How would you define the “self?”

Dr. Summers: The “self” is our articulation of our potential through authentic ways of being and relating. The authentic self will naturally promote activity, creativity and self agency in its expression. This contrasts with the false and pathological selves in character disorder patients, which inhibit all of these potentials. In the character disorders, or any pathological state, the potential self is buried underneath protective defenses so that self formation is arrested.

Dr. Kavaler-Adler: Would you call this negative early self-other constellations seen in character disorders and/or in neurotic patients, “internal saboteurs” or “internal antilibidinal egos” as Ronald Fairbairn did?

Dr. Summers: A good deal of my thinking is influenced by Fairbairn, particularly in relation to the pathological incorporations that seal patients off from contact with new healthy modes of relating with others, promoting schizoid splitting. Consequently pathological incorporations inhibit the formation of authentic ways of relating to others. I agree with Fairbairn that there is an attack against self-other contact, but terms such as “internal saboteurs” and “anti-libidinal ego” tend to be reifications.

D. W. Winnicott has also greatly influenced me. I have drawn on his theory of potential and transitional space to define an important aspect of clinical treatment, all of which is related to his theory of the true and false self, and to his theory of “The use of the object.” Winnicott, like myself, always saw the developmental use of the psychoanalyst as an “object” to be of primary importance in clinical treatments, where authentic self development was a primary goal.

I believe that psychoanalytic psychotherapists need to employ interpretation to dismantle old defensive modes of enactment that forestall self development. In addition, however, clinical experience has shown that one must go beyond interpretation to allowing a transitional space to form new and more vitally spontaneous self in order to facilitate development. The analyst needs to both engage the new self potential and provide a place for it. Ego psychologists have neglected to account for the whole area of new self development in their view of treatment. I agree with ego psychologists that interpretation is an essential clinical tool to dissolve defenses that perpetuate pathological functioning, but I believe the analyst must help the patient articulate the buried self potential that lies beneath the defenses, and I do not think ego psychology accounts for this aspect of therapeutic action. I sharply differ with those self psychologists who throw out the use of interpretation (but this is not true of all of them) as well as with those relational theorist who are headed in that direction because without interpretation any new relationship is in danger of remaining superficial, out of contact with the patient’s core. I part ways with the ego psychologists when they neglect to facilitate new and future oriented self development. Such self development occurs within the treatment situation, where a Winnicottian “holding environment” can provide an evolution of transitional or “potential space” for the arrested self to articulate itself, as I said in the last chapter of Transcending the Self.

Dr. Kavaler-Adler: Could you elaborate on your disagreement with the ego psychologists related to the necessary but not sufficient use of interpretation?

Dr. Summers: Well first of all, I do not agree with the ego psychologists that all you have to do is interpret and the changes will come. Sometimes interpretations are mutative and sometimes not. Frequently interpretations are followed by a patient saying, “I understand what you’re saying, but I don’t know what to do with it.” Then nothing changes.

Dr. Kavaler-Adler: Don’t you think this kind of intellectualized response to a interpretations can be worked with, for example in terms of trying to understand, as the Kleinians do, what core anxieties lie under such an intellectual response? Would you attempt, as the Kleinians do, to use interpretation to help the patient symbolize the underlying anxiety that the patient cannot put into words? In other words, would you as an analyst process the patient’s split off experience, which may be enacted on you on a preverbal level through projective-identifications?

Dr. Summers: Such a response is not necessarily intellectualized. Even after the patient has a deep, affectively meaningful insight, she may not be able to change because the insight has not helped create new ways of being and relating. I find the Kleinians, particularly the modern Kleinians, like Betty Joseph (who uses Bion’s idea of the analyst being a container to process the patient’s pre-verbal or enacted beta elements), to be very useful. However, I find the Kleinian approach most useful in relation to the borderline patient, where I do believe it is absolutely necessary to process the projective-identifications of the patient. But remember: such processing is not interpretation. Sometimes, one has to be a container who silently processes the split off enactments of the patient, allowing for a transitional space, where the rage of the patient can be expressed repeatedly, as Winnicott talks about in “The Use of the Object or Relating Through Identifications.” The therapeutic action of this processing lies in the patient’s reaching the analyst’s subjectivity, which begins the movement from object relating to object usage. None of this is interpretive. Labeling self-object patterns is important, but the mutative factor is the space this process opens for the articulation of dormant potential. I do believe that aggression is very important, particularly in the case of developmental arrest in the character disorders. However I’m more partial to Winnicott than to Klein in relation to the therapeutic action needed in response to the repeated expression of this aggression, particularly when it is the raw, primitive and inchoate aggression of the protosymbolic form that has no differentiated self to object message, but rather is part of an instinctual move out of psychic isolation and into reality and separation. Such aggression needs to be survived, and its purpose recognized.

Dr. Kavaler-Adler: So you believe in Winnicott’s concept of object survival, as opposed to interpretation that might too soon bring the experience of the aggression to a symbolic level, risking more intellectualized false self development? You believe that the analyst must tolerate the expression of aggression related to Winnicott’s preoedipal “unthinkable anxieties” in those without a separate and individuated self. In this case, tolerance implies survival in the sense of not retaliating through interpretations that will be taken by patients on that level of trauma as annihilating accusations or attacks, since such patients are not operating on a symbolic level when they regress into such enactments of rage. In other words, you believe, as did Winnicott, that an analyst must allow themselves to be “killed off,” particularly by “false self patients,” in order to survive as an external object, beyond the fantasy range of “omnipotent control” of the patient? You believe in the midst of such primitive rage, which James Masterson has referred to as part of an “abandonment depression,” and Winnicott has linked to “unthinkable anxieties,” given that the self is threatened with extinction that the analyst needs to survive by refraining from emotional abandonment and from retaliation? Do you believe in object survival, as opposed to interpretation, when the patient projects retaliation into the analyst as the analyst is interpreting, even if the analyst is not counter transferentially aggressive, since the patient’s developmental limitation, based on early trauma, doesn’t allow the patient to take in the symbolic message of the interpretation?

Dr. Summers: Yes, up until the last clause of your question. The reason the patient cannot use an interpretation to change is not due to the developmental level of the patient, but because words cannot effect changes in the self. Patients do take in the symbolic message, but they do not know what to do with it because the message cannot to help the arrested self unfold. Nonetheless, to get to the point where object survival can happen and transitional space for new self evolution can emerge. The clinician must use all the arts of interpretation that we have been taught. The old false and pathological self can only be dismantled through the patient’s awareness of how his/her pathological self/object constellations operate. No patient can relinquish such constellations without the awareness of how these constellations operate in the therapeutic relationship and in the transference, and such awareness necessitates the use of interpretation. You cannot build a new and healthier true self through defensive structures. The defenses must be dismantled through the awareness that comes with incisive, repetitive and differentiating interpretations. Without awareness of the defenses the patient cannot choose to face the fears of relinquishing the old defensive constellations that are attached to the original parents and to their pathological parts and enactments upon the initial child self, as has been stated so well by Fairbairn. Without relinquishment there is not potential space for authentic self to then evolve. Only understanding how the defenses operate in the present, and particularly in the clinical situation, can bring such awareness.

The relational theorists are dangerously close to swearing off interpretations and this is weakening their position considerably. The relational people speak of offering the patient a new relationship without a clinical and developmental theory behind it.

Dr. Kavaler-Adler: I guess the incompleteness of the relational theorists’ view is inevitable once they dispute our most basic understanding of psychic structure and of the internal world of latent and potential psychic fantasy. It’s hardly an adequate substitute for learning about psychic structure and its relationship to development, and about the internal world and psychic fantasy to speak about a transitional space in an interpersonal world that reflects the unconscious in all its manifestations, especially if they’re simultaneously speaking about transitional space as an open space for the new self to emerge. But besides the movement towards disregarding interpretation and all our traditional concepts of defenses, are there any other difficulties you have with the relational theorists?

Dr. Summers: Well yes. The relational theorists do not seem to make any distinction between a healthy and authentic self and a self that just does new things in response to a novel relationship with an analyst. If they do in practice, they don’t in their theory, a disjunction I often find in their writing. It is not enough to provide a new relationship and hope that something new will develop in the patient’s behavior behavior that will reflect something better in the psyche. Also, relational analysts often talk in terms of a revolution to a “two person” model in which all material must be looked at as “co-created” between patient and therapist. Sometimes this is referred to as a change in the unit of psychoanalysis to the “relational field.” Such a posture not only limits the analyst considerably, it is fundamentally impossible. When relational theorists discuss cases, they immediately abandon this model because they have to in order to be responsive to the patient. Once they try to understand the patient’s self, they have abandoned their revolution.

Dr. Kavaler-Adler: But getting back to my point, something new is not necessarily something better. In other words, there is no room for experience in the moment to create the new if the person is sealed off in a Fairbairnian closed system. In this case, the patient would be residing in an echo chamber of old attachment patterns, operating dynamically as if the original objects were perpetually enacting sadomasochistic submissions and anybody outside this closed system, existing in the external world, doesn’t exist or exits only through the externalization and projection of the internal pathological constellations onto the outside objects.

Dr. Summers: So without dismantling the constellations of old bad object constellations, operating as defensive and warded off operations, there is no new encounter with an analyst or with any other external object. If an analyst wasn’t required for interpretation, as well as containing, which involves an active processing of the patient’s enactments, any new object could effect cure. The relational thinkers really are in danger of falling into this trap. If you follow their belief that all that’s needed is a new and hopefully healthier relationship that offers new modes of relating, you are left with the view that a friend or spouse will do. Who needs an analyst? If this were true, my wife could cure me just by relating to me. This is far from the truth as we all know. Yet, when the relational theorists throw out defense interpretations, along with throwing out any understanding of psychic structure as related to different levels of self formation through separation, resolution of psychic conflict and self authenticity, they are left with the view that mere novelty from an object outside the patient’s pathological system. Now I don’t believe any relational analysts really believe this, but I don’t see how they can avoid this conclusion given their theory of therapeutic action. Although some speak of the symbolic function of the analyst, they don’t speak of this in relation to defense interpretation that is based on an understanding of psychic structure and character disorder structure.

One needs a concept of authenticity, of the true self, whether one calls it a “nuclear program” á la Kohut or a personal idiom á la Bollas, to distinguish between the “merely new” from “new and healthy.”

Dr. Kavaler-Adler: What about self psychologists?

Dr. Summers: Well, I respect many contributions of the self psychologists, as I have stated in my books, and the focus on the relationship between self and object as the main concern of treatment is one I share with them, but there are several problems as well as contributions stemming from their approach.

First of all, even more than the relational theorists, some self psychologists swear off interpretation. As I have stated, such a view of treatment lacks any effective means to true psychic change. Some patients have primitive defenses, like splitting, projective-identification, primitive idealization and omnipotence, etc., but all these defenses eventually require interpretation so the patient knows how they are sabotaging themselves in a repeated basis. Early phases of mirroring, holding, or containing may be required with patients who have severe narcissistic disorders, but the narcissistic issues based on profound psychic clinging to old attachment modes, on which primitive and false self has been based, must be addressed by interpretation.

Secondly, self psychologists tend to view the self as a passive recipient in both development and therapy. They want the therapist to be too attuned to the patient, in my opinion. To be attuned means that there is no transitional, analytic, or potential space between the analyst and patient in which self development can take place. Too much attunement and too little transitional space does not allow for the active creation of self and what Winnicott has described as essential to true self development. To speak of a self rupture, displaced from the past to the present, as if it is the result of an “empathic failure” in the analyst, where all activity is seen in an externalized form as the other’s “fault” related to the patient’s passive reactive injury preserves the patient’s regressive “innocence.” Kohut promoted this view, which most self psychologists follow, although differences among self psychologists is proliferating now. Winnicott and Kohut have contrasting views of the self. Winnicott speaks along the lines of active imagination, creation and the spontaneous gesture while Kohut emphasized “transmuting internalization,” a passive process.

Dr. Kavaler-Adler: Some of what you speak about reminds me of James Masterson’s clinical theory, which grapples with a forestalled self-activation process in character disorders. This view requires the reliving of the original trauma’s pain to free the self to self activate, and involves a developmental mourning process related to a whole abandonment depression. No external response from the analyst, in itself, can accomplish this. The patient has to go through the intense frustration and pain of initiating self activation to begin to remember, and thus mourn the past parental opposition to self activation in the patient as a child.

But what would you cite as a positive contribution of the self psychologists?

Dr. Summers: Well their overall view of the self as the main psychic focus for clinical treatment is one I believe in and share. I see an object relations understanding of development to be one in which the evolution of the self is the goal of object relating, object usage, and object internalization. Also, the concept of the “nuclear program of self” is very useful for understanding health and pathology. Furthermore, self psychologists have some awareness of the role of disintegration anxiety in the recalcitrance of patterns. Third, self psychologists grasp the importance of the parent’s and analyst’s seeing who the patient is. One of the critical parental functions is to make the child visible to himself, and Kohut saw this in development and in analysis between analyst and patient. Finally, the self psychologists have shown the importance of the analyst’s responsiveness to the patient’s mental states.

Dr. Kavaler-Adler: Some say Kohut actually plagiarized Winnicott and Fairbairn because he never gave them or anybody else any credit for their ideas. Kohut actually lifted whole phrases from Michael Balint in the Basic Fault. Perhaps Kohut feared annihilation if he were to acknowledge anyone else.

Dr. Summers: Nevertheless, Kohut did speak of the vulnerability to self fragmentation in many patients and this leads into an awareness of the threat that I speak of as “annihilation anxiety,” which I see as fundamental to the recalcitrance of pathological patterns.

Dr. Kavaler-Adler: Winnicott first spoke of annihilation anxiety as the “unthinkable anxieties.”

Dr. Summers: Yes.

Dr. Kavaler-Adler: Currently, Dr. Marvin Hurvich has written extensively about annihilation anxiety, from his Freudian and Kleinian perspectives.

Dr. Summers: Yes, Winnicott’s theories on the “unthinkable anxieties” have been influencing us all as we struggle with failures in the use of words and interpretations to promote change in character disorder patients and even in neurotics who fear loss of their familiar identities.

When I spoke of the diminishing returns from interpretations as patients exclaim: “I understand what you’re saying but it doesn’t help me,” I was speaking of the manifest patient behavior that I believe cannot be addressed with interpretation alone. What I’ve found clinically, as I describe in Transcending the Self, is that words fail when the patient’s terrors are at the preverbal level where the preverbal trauma occurred, at the point of the sealed off core self object as Fairbairn would describe it, or at the point of the “unthought known” as Winnicott would call it.

Dr. Kavaler-Adler: To relinquish old internal object relationships at this point in treatment, to join the analyst in new relating in the transitional space is at first too terrifying for those with trauma in the early years of primal self development.

Dr. Summers: Right. The risk is too great because relinquishing the old relations, no matter how self sabotaging and no matter how painful in their repetition, threatens loss of self, not just loss of a love object. A total loss of identity threatens. A neurotic also fears loss of self and resists change, but a character disorders patient fears annihilation.

Dr. Kavaler-Adler: I would call it “terror.”

Dr. Summers: Yes, the character disorder patient is terrified of total self loss, beyond even self fragmentation, and certainly beyond the mere loss of the familiar. Fairbairn was the first to speak about relinquishing the bad object, which is the original negative parental object as a trial of losing the self, not just losing love or an entire object and its relationship. Since the self is still merged in with the early object in the split off world of the character disorder patient to let go of relating to the analyst and everybody else as though they were the old object, threatens total loss of a sense of self. The patient is confronted with feeling all kinds of archaic disorganization, emptiness, void, rage and depersonalization and dissociation in reaction to not feeling who he/she is.

Dr. Kavaler-Adler: Emily Dickinson’s poetry captures this state of depersonalization at the point of such threat. Dickinson’s best poetry was written at the time of annihilation anxiety terror and at the point of depersonalization ad dissociation. Unfortunately, since she didn’t have an analyst to see her through it, and she was forced to regress into a rigid schizoid defense organization, eventually her creativity dried up-as I speak of in my book

Dr. Summers: There needs to be an analyst to `catch’ the patient,” when the patient risks relinquishing the old object ties and faces the psychic perils of annihilation anxiety because such a state can be successfully traversed with another. This is Winnicott’s distinction between withdrawal and regression; the analyst’s job is to turn withdrawal into regression. Because Emily Dickinson did not have anyone to do this for her, she was left stuck in a state of schizoid withdrawal. In analysis we have our presence as analysts, a holding environment that helps the patient to shift potential withdrawal into regression, creating the possibility of a new beginning.

Dr. Kavaler-Adler: Do you speak about the analyst catching the patient as Winnicott and Ogden (1986) speak of the infant being caught by the external mother when the internal psychic fantasy mother is surrender?

Dr. Summers: Yes.

Dr. Kavaler-Adler: What other holding functions does the analyst provide that extends the analyst’s role beyond that of interpreter?

Dr. Summers: I see the role of the analyst combining an interpreting function with holding and containing functions. One important aspect of the holding is the analyst’s ability to sense the patient’s true self potentials even before the patient can. When the patient well understands certain patterns, but cannot change them, I believe the analyst opens up a transitional space in which the patient can experiment with new ways of being and relating. The analyst’s task is to hold the situation while the patient creates new modes of becoming what was only potential.

Dr. Kavaler-Adler: Do you mean that she/he would anticipate the patient’s self realization while it is still in potential form and as yet unknown to the patient?

Dr. Summers: Yes. I believe as Bollas does that the patient has a personal idiom, with an innate origin, that determines the potential of any one individual. The patient may have no, or minimal awareness of the potential. So, the analyst must see it before the patient can, but the analyst’s vision must come from what we see in the patient. Loewald saw this dialectic: we are always one step “behind” because the patient’s material leads us, but also one step ahead because we see potential in this material that the patient cannot see.

Dr. Kavaler-Adler: Is the idiom like an innate blueprint that can unfold with facilitation of the environment as in Winnicott’s concept of a facilitating environment, which allows the developmental journey to advance in any one individual?

Dr. Summers: Yes. The idiom suggests a potential direction for the self to develop but that direction needs to find fulfillment through the responsiveness of the caretaker in childhood and through the responsiveness of the analyst in a reparative object relations analysis. If that responsiveness is lacking childhood and if the parent is retaliatory, withholding, attacking or abusive, then the self idiom will remain as a potential that is arrested and inhibited. The intense and traumatic frustration around the arrest of this self potential will necessarily lead to a form of hostile aggression that my look like the impulses of a drive, but which I see as affect states related to developmental trauma. The appearance of aggression as impulse I see as secondary to another issue, such as injury to the self or the inhibition of assertiveness. Whatever the particular issue, the impulsive aggression reflects an arrest of the self that has become intolerable.

Dr. Kavaler-Adler: So you do not see aggression as a drive. You relate what is normally thought of in the psychoanalytic literature as aggressive drive impulses to affect states.

Dr. Summers: Yes. I see aggression in children as a natural response to frustration, which has a natural cessation when the frustration ends, as Parens (1979) has shown. I see aggression as a healthy force, as Winnicott did, as an opening up true self expression. In those traumatized, where the natural developmental idiom of the self has been arrested, aggression as an individuating force is malignantly transformed into explosiveness.

Dr. Kavaler-Adler: But Winnicott did see aggression as a drive, even though he saw it as having developmental functions related to self expression, particularly in those traumatized.

Dr. Summers: Winnicott believed aggression was inborn, but he did not see hostility or explosiveness as inborn. Remember, Winnicott believed the erotic and the aggressive are naturally fused, so that not only is the erotic aggressive, but also aggression is naturally joyful. In his words “the infant must get a kick out of kicking.” He regarded hostile outbursts and explosiveness as reactions to frustration, rather than inborn drives.

Dr. Kavaler-Adler : How do you see aggression as providing developmental functions?

Dr. Summers: In development, aggression helps the infant define boundaries for the self, separate from early objects, move from fantasy to reality. Aggression also helps the child to master the world and develop ambition. In treatment, I see the expression of hostile aggression in those traumatized as a means of setting a boundary with the analyst when the borderline patient is terrified of succumbing to his/her own merger wishes. The borderline patient is terrified of self-annihilation or self dissolution in fusing into the other with whom one wishes to merge. I also see the killing off of the analyst again and again as Winnicott first spoke of, and later spoken of by Jessica Benjamin, as a testing for safety in the environment. If the character disorder patient can release the intense and hostile affect of aggression that has been inhibited through repression an dissociation and feel safe in an atmosphere, where the analyst hears the message behind the aggression, while refraining from retaliation, the external object, represented by the analyst, can be psychically connected to. The analyst becomes real and three-dimensional. The patient has moved from object relating to object usage, or, in other terms, from the part object level to the whole object level, or, as Benjamin would say, to a new level of intersubjectivity.

Dr. Kavaler-Adler: One of my analysands began to call me a master of negative transference, because I would listen to her aggressive attacks with interest and without retaliation. She couldn’t believe I could listen and even investigate the differentiated meanings that could come out of the aggressive attacks without retaliation, because her parents had always retaliated, her mother withdrawing and giving her the silent treatment. I could see how my non retaliation was crucial to allowing her to move from aggression to anger and more and more into feelings of sadness mixed with both loss and yearning. A full developmental mourning and grieving process could unfold as sadness was tolerated and depressive position concern could be felt for the analyst for the first time. Do you see aggression in developmental terms leading to mourning.

Dr. Summers: I see the need for mourning in relinquishing the old internal parental objects. The holding of aggression is one way this can happen, but only one. A merger relationship for patients who have a fragile self is another. For patients with what I call an inadequate self, affective responsiveness can accomplish this aim. Do not see the privileged role for aggression in the relinquishment of old objects, as some people do. I have had clinical experiences much like you describe, but I have also had patients for whom my acceptance of their love had the same result: the relinquishment of the old object.

Dr. Kavaler-Adler: You mention mourning in a few clinical cases in The Transcending of the Self , but you don’t seem to focus on it as of prime developmental significance as I do.

Dr. Summers: My focus has been elsewhere, as in providing psychic merger experiences with borderlines without collapsing the transitional space and succumbing to physical holding or physical merger. To provide psychic merger I allow fears of action in treatment that I see as potentially expressive of the true self as opposed to being mere acting out. I see the importance in all cases of relinquishing the old objects, but my focus tends to be on the loss of self that results and the attendant annihilation anxiety.

Dr. Kavaler-Adler: Are you referring to Michael Balint’s distinctions between benign and malignant regression?

Dr. Summers: Yes. Balint’s distinction is a useful way of defining the difference between retreat and a new beginning. It is the analyst’s task to transform a retreat into a new beginning. As Balint pointed out, this task requires responsiveness to the patient’s needs, not simply interpretation. I allowed one borderline patient to bring her kitten into a session and to have me play with it a little, or to lie down on a couch covered with a afghan. I held this situation until she was ready to emerge from it. Another patient called me frequently in a panic because she lost me and feared I lost her. The only way I could get her to re-connect was to lower my voice to a soft hum, a sound that immediately made her feel I was there and the anxiety disappeared. I did this over and over until she felt my presence within her. Then, and only then, could she embark on a new beginning.

Dr. Kavaler-Adler: I’m sorry we don’t have time for more. This has been very interesting.

Reviewer Note

Susan Kavaler-Adler is the Founding Director of the Object Relations Institute and the author of, The Compulsion to Create (Routledge, 1993) and The Creative Mystique (Routledge, 1996). Her third book, Mourning and Psychic Transformation will be published by Jason Aronson. Dr. Kavaler-Adler has been in private practice for 23 years and conducts writing, creative and mourning groups and workshops.


© Division of Psychoanalysis, 1999-2011, Book reviews are Copyright 2002-2011, Division of Psychoanalysis of the American Psychological Association. Readers therefore must apply the same principles of fair use to the works in this electronic archive that they would to a published, printed archive. These works may be read online, downloaded for personal or educational use, or the URL of a document (from this server) included in another electronic document. No other distribution or mirroring of the texts is allowed. The texts themselves may not be published commercially (in print or electronic form), edited, or otherwise altered without the permission of the Division of Psychoanalysis. All other interest and rights in the works, including but not limited to the right to grant or deny permission for further reproduction of the works, the right to use material from the works in subsequent works, and the right to redistribute the works by electronic means, are retained by the Division of Psychoanalysis. Direct inquiries to Bill MacGillivray, editor, Psychologist-Psychoanalyst.

To contact Dr. Kavaler-Adler, please call 212-674-5425 or email DrKavalerAdler@gmail.com.

Office address: 115 East 9th Street, Suite 12P; NYC, 10003


***Over 35 years Experience in Psychoanalytic/ Psychodynamic/ Object Relations Psychotherapy with Individuals, Couples, and Groups, while utilizing unique approaches to working with: ***Depression, ***Anxiety & Fears, ***OCD, ***Loss, Grief, & Mourning, ***Self-Sabotage/ Abandonment & Separation, ***Guilt & Shame, ***Trauma & PTSD, ***Relationship & Betrayal Issues, ***Divorce/ Domestic Abuse & Violence, ***Dissociative Disorders, ***Elderly Persons Disorders, ***Gay Lesbian Issues, ***Parenting issues, ***Blocked Creativity, ***Spirituality, ***Personality Disorders & Borderline Personality. ***Supportive therapeutic groups: Self-Sabotage, Fear of Success, & Fear of Envy; Developmental Mourning; and Creative Healing Writing. *** Group supervision for Mental Health practitioners: Utilizing the Object Relations approach in therapy, and Envy issues in personal and professional life of therapists.***Additional modalities utilized: Guided Psychic Visualization, Creative Writing, Life Coaching, and Dance Therapy.

Contact Dr. Kavaler-Adler: call 212-674-5425 or email DrKavalerAdler@gmail.com


* Copyright © 2000 Dr. Susan Kavaler-Adler * All Rights Reserved.
 Website is created  and maintained by MindMend Media & Publishing (www.mindmendmedia.com)