Danckwardt,J. F.: Int J Psychoanal (2010) 91 :431-461 Book Review
Translated by Sophie Leighton.
Traum, Wahn und Mikrowelten. Affektregulierung in Neurose und Psychose und die Generierung von Bildern' {Dreams, Delusions and Micro-worlds: Affect Regulation in Neurosis and Psychosis and the Creation of Images} by Ulrich Moser Brandes & Apsel, Frankfurt, 2008; 220 pp; €24.90
In their article Computer simulation of a model of neurotic defence processes, Ulrich Moser and Ilka von Zeppelin (Moser, 1969; von Zeppelin and Moser, 1973) suspended the traditional interpretative access to dreams and undertook a descriptive coding approach. They thus began to formulate models for the creation and transformation of dreams ( and von Zeppelin, 1991, 1996). With Thomas Stompe in the present book (Chapter 3), this approach is extended to the phenomenon of delusions. Here Moser, emeritus professor of psychology and clinical psychology at Zurich University, and a psychoanalyst of the Swiss Psychoanalytical Society/IPA, summarizes this further stage of his research that uses precise methods for coding phantasies. I will discuss this in more detail below, and begin by just indicating a few important premises. Moser conceives dreams and delusions to be virtual micro-worlds. They occur mainly in (linguistic) images and linguistic scenarios. These are shaped by affects. They are partly overlain by thoughts and reflections. In the images, the subject moves across times, places and relations. Since Moser conceives the imagistic worlds of dreams and delusions as a form of simulation and transformation of inner self-experience, they represent models for processes of change. They primarily reflect the human being's processes of inner change. This makes them and their study extremely interesting for modern research in psychotherapy.
The technique and interpretation of coding are conveyed to the reader. Coding was developed by Moser and Zeppelin, and validated by Döll- Hentschker (2008), as well as exemplified by dream sequences from one situation to another in psychoanalyses. They then developed the procedure correspondingly for delusions. The categories of the coding are the determination of the positional range, the temporal localization, the spatial localization, the spatial shift (leaving and entering), the situational sequence of the micro-world, the internal structure of the situation, the cognitive processes and models of the self as forms of subject-processors. By analogy with dream analysis, the form of relationship that arises in the situation and the theme of the interaction, far instance, are observed. This involves registering categories such as responsive relationship, resonant relationship, communicative relationship, interaction with or in the subject with no external impact, mental process, physical process, displacement of the interaction, secondary interactional field in the displacement, verbal relationship and the subject-processor's auxiliary relationships. This kind of encoding is said to be an indispensable methodical tool for undertaking any empirical testing of a theory. First, it serves to test the rigour of the theory: is every phenomenon recorded and connected with a particular model? In that case, comparisons of micro-worlds belonging to an individual person of groups of people, as well as delusional stories and dream reports from an individual subject or from specific pathologies, can be better examined through coding systems.
The author demonstrates the methods, advantages and problems of coding by assessing a dream narrative from the psychoanalyst R. Zwiebel, a child-analytic therapy session from the psychoanalyst Edna Q'Shaughnessy and the delusional stories of a schizophrenic patient from Thomas Stompe together with Holzer. The final chapter addresses visual artistic compositions as micro-worlds of delusional patients. They are said to be narratives of a special kind, a materialization of visual images, not expressed in words, but created visually, haptically and kinaesthetically. Moser therefore also construes them as very early forms of reflexivity. They correspond to a 're-entry' from the 'intermediate world' of externalization or projection into the resumption of the theme, now with lesser anxieties and affects; it is therefore a resumption of the subjective theme under better conditions for inner change. Pictures by H. Scherer, A. Wölfli, M.C. Escher and a young psychotic's self-portrait amplify the examples of how delusional subjects protect themselves from affectively intolerable catastrophes.
Introducing the 're-entry' concept brings the author on to some general thoughts on psychotherapy as a 're-entry' process. The coding methods reveal some essential new differences between dreams and the delusional process in the depletion of affect, affect-regulation and delusional transformation: ”The constant depletion of affect, the separation of panic-type affects from cognitions and the avoidance of intentional feelings, which would instigate an object-relationship, were described as essential components in the delusional formation.” (p. 133)
Delusion is said to contain additional transformations that cannot be found in dreams. A transformation into a virtual reality is said to occur, in which a specific consciousness is said to dominate that resembles neither sleeping nor waking consciousness, in which the delusional subject can "subsist for a considerable time" (p. 11). This does not apply to dreams. However, it is also accompanied by a loss of transformational potential in regulating interactions that corresponds to a loss of the loss of human being’s intrinsic possibilities for inner change. It is said to enforce an increased frequency of self-regulation by means of the subject's rapid changes across relations, times and places. However, this produces a delusional self-model that fails to secure the delusional patient a concentration 01' the auto biographical micro-worlds into a macro-world: "Every micro-world of delusion is [at the same time] also the macro-world" (pp. 13, 73, 152).
The author closes his pioneering work on the processes and dynamics of dreams, delusions, images and the fine arts consistently by indicating that: "Our [scientific] theories are in fact also micro-worlds that are similarly subject to restrictions in the scope of thinking and our affective possibilities" (p. 220). This method of investigation will be of great value to any researcher concerned with psychoanalytic theory, its rigour, testing and evaluation, with non-statistical qualitative comparisons of individuals or groups, as well as with qualitative longitudinal studies of the course of treatment.
Joachim F. Danckwardt Im Buckenloh 2, 0-72070 Tübingen, Germany E-mail: JFDanckwardt@t-online.de http://danckwardt.homepage .t-online. de
References Döll-Hentschker S (2008). Die Veränderung von Träumen in psychoanalytischen Behandlungen. Affekttheorie, Affektregulierung und Traumkodierung. Frankfurt a.M.: Brandes & Apsel. Moser U (1969). Computer simulation of a model of neurotic defence processes. Int J Psychoanal 50:53-64. Moser U, von Zeppelin I (1991). Cognitive-affective processes: New ways of psychoanalytic modelling. Berlin: Springer. Moser U, von Zeppelin I (1996). Der geträumte Traum. Wie Träume entstehen und sich verändern {The dream process How dreams emerge and change}. Stuttgart: Kohlhammer. von Zeppelin I, Moser U (1973). The application of the simulation model of neurotic defence mechanisms to the psychoanalytic theory of psychosomatic illness. Int J Psychoanal 54:79-84.
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Danckwardt,J. F.: Int J Psychoanal (2005)
Book Review (Translated by Sophie Leighton, MA (Oxon), MA (Sussex):
Hartmuth König (2000): Evenly suspended attention and model-formation. A qualitative systematic case study of the psychoanalyst’s cognitive process [Gleichschwebende Aufmerksamkeit und Modellbildung. Eine qualitativ-systematische Einzelfallstudie zum Erkenntnisprozess des Psychoanalytikers]Ulm: Ulmer Textbank. 2000. 529 pp.
This book weighs 875g: a magnum opus. Its material weight artistically stages a carefully chosen cover theme. This is the reproduction of a watercolour by Hans Peter Reuter from 1989, which is entitled Light-space 500. The viewer perceives a column-like ‘uncertain hovering’ (pp. 284–95) between light and darkness, white and blue, which graduates into the space. It is not unlike the dynamic logo used by the news broadcaster, NTV. With this, König illustrates ‘the field change of active imagination’ (p. 295) and his deepened understanding of an aspect of the psychoanalytic cognitive process known as evenly suspended attention. This was worked out by Freud, its founder, in 1900 and 1912 as a central component of the psychoanalytic attitude. It conflicted then as now with the highly conscious and focused working method of the western intellectual and scientific tradition. Through evenly suspended attention, which first and foremost integrates emotionality as a part of both our active and our passive lives into the cognitive process, the psychoanalyst strives towards the capture of the unconscious and its ‘alternative, unprocessed meaning resources’ (p. 219), and thus towards interpretive options and formations that contrast with the ‘selective meaning constructions’ that are often rapidly reinforced in other forms of therapy. Emotional experiences of this kind are constantly represented in words in situational and dramatic form (pp. 300, 306). However, they are often perceived only as proto-thoughts (Bion) and not truly actualised, or else avoided altogether (p. 313). This means that what has been guessed is then disavowed. Retrieving and elaborating it requires not only the psychoanalytic attitude but also, König argues, an explication of the ‘selective filter effect of models’ that are constantly contributing to the cognitive process (p. 284).
König’s work is a broadly structured thesis that is considered in a highly sophisticated way and carefully developed in a series of explanatory stages, while also being highly enjoyable to read. The author is a psychologist, psychoanalyst and a training analyst and supervisor in the German Psychoanalytical Association. A long-standing scientific researcher in the department of psychoanalysis, psychosomatics and psychotherapy at Tübingen University and simultaneously participating in health-insured medical care, he has an ample knowledge of his subject: the study explores the problems concerning the context of emergence for interpretations in the therapist. There is, he indicates, hardly any systematic empirical knowledge about this specific characteristic of the psychoanalytic practitioner. The selection and discussion of the primary and secondary literature, as well as the acknowledgements, demonstrate that König has already been creatively engaging with the material and the researchers concerned with it for over 25 years. The project, which uses expensive transcriptions among other material, was conducted with the support of the Breuninger Foundation in Stuttgart. Sporadic earlier publications in IJP already appeared to be paving the way towards an overview.
König begins by explaining the question at issue, namely the psychoanalytic cognitive process, its theory and the conclusions that can be drawn from more recent research. He considers the cognitive process primarily in terms of its continuous structure and its interplay of experience and theory, balanced with modular thinking. König assesses the persistence of the modular concept and then adopts an interdisciplinary position in relation to the modular scenes described by Lachmann and Lichtenberg, to Bion’s concept of model-formation and to Peterfreund’s standpoint between heuristic strategies and models. König develops aspects of an integrative framework for cognitive theory that incorporates the temporal, hierarchical and interactional extension of models—situational concepts and persisting modular structures, the patient’s working models and the analyst’s psychoanalytic meta-models (such as transference/countertransference). Models are conceived as an ‘inference space’ (p. 147). In this, modular thinking assumes the status of an intervening phase between evenly suspended attention and sensory (p. 221) and emotional (p. 86) experience, as well as theory.
A detailed chapter is devoted to the discussion of the phases of psychoanalytic therapeutic research pertaining to this question. This is followed by the discussion of the procedure devised for the study, which is prefaced with the fundamental question of which material can be accessed using which procedure. First, there is the factual starting-point: a therapy session and the treating analyst’s review of the session, as well as the explanatory conversation. Then there is the evaluation: detailed commentaries on the verbatim transcript, the tone registered, the session review and the explanatory conversation in the light of the initial relational theme, as reflected in the greeting at the beginning of the session, its relational background, the break within the therapy, the patient’s wishes concerning availability and the path of interpretation actually adopted by the treating psychoanalyst.
The study demonstrates that interpretive acts are determined by conscious and preconscious modular structures and that meanings alien to these models are screened out. Corresponding perceptions are excluded from further processing (p. 430). The therapist is therefore not truly actualising situation-near process knowledge and memories of acts (p. 430). Evenly suspended attention encounters narrower limitations through working models and meta-models of treatment technique than official theory postulates (p. 412). Evenly suspended attention is therefore, like all psychoanalytic concepts, subject to private and implicit theory-formation (as described in Sandler, 1983). The assumption that the countertransference—as perceived through evenly suspended attention and analysed—determines the model-formation seems one-sided and incomplete (p. 410). However, modular structures operate as a filter on perception and processing (p. 408). Bion’s prototypical model for the actual genesis of insight understood as newly arisen in the here-and-now as an emergent pattern from scattered elements is accordingly qualified (p. 409). The reviewer would add—qualified by the factor of the unexplicated inference space? And does a methodically argued explication of the filter effect of the models that are constantly contributing to the cognitive process turn evenly suspended attention from a normative competence into a privileged competence in Spence’s sense?
The attentive and enjoyable pursuit of the approach taken in this study and its implementation provides the reader with a further benefit, namely König’s attempt at methodological innovation, in which he ‘goes beyond a general investigation to explore the psychoanalyst’s inner workings’ (p. 8). What König may first and foremost describe as an innovation is his procedure that he can classify as a ‘method based on hermeneutical dialogue in qualitative social research’ (p. 11), for which he feels indebted psychoanalytically to Sandler’s (1983) conception and Spence’s concept of naturalisation (1981, p. 106) and which he concludes by critically assessing (p. 430).
The reader encounters a further innovation. The application of modular thinking, comprehensible in stages, reveals the significance of the functions of model-formations: their epistemological, representational, selectional, heuristic and illustrative functions. By an exemplary implementation of this form of thinking, König manages to establish in the realm of the preconscious and unconscious the dimension of a defined form of judgement capacity that can free psychoanalysis from dogma-construction. König demonstrates that the concept of model-formation as an inference space provides psychoanalysis with a judgement capacity that renders suppositions about the unconscious susceptible to justification or refutation, in the same way as suppositions and judgements with a different provenance. With guidance and practice in this kind of thinking, the reader is manifestly relieved of the hagiographic burdens and belief-forming orientations of particular schools. This kind of unburdening effect inevitably leads the reader on to develop from the clinical case description and the disclosure of the session an independent ad hoc model, a working model derived from this and finally an alternative meta-model for the necessary treatment technique (p. 276). König had of course also thought of this variant but rejected it as improbable. Surprisingly, the reader felt his own ad hoc model was supported by the patient’s biographical material as expounded at the end (pp. 339, 345) and could then go on to consider the researcher’s selectional function. The study thus leads beyond its substantial academic and encyclopaedic value and on to practical psychoanalytic and scientific thinking. Its place on the reading list for training institutes is therefore not in question for the reviewer. The answers to Freud’s question as to whether psychoanalysis should be taught in universities have been impressively amplified by a new dimension.
References
Sandler J (1983). Reflections on some relations between psychoanalytic concepts and psychoanalytic practice. Int J Psychoanal64:35–5.
Spence D (1981). Psychoanalytic competence. Int J Psychoanal62:113–24.
