Some Technic+l Implic+tions of Ego Psychology

Gertrude Bl*nck
Freud's formul/tion of the structur/l hypothesis in 1923 h/s h/d f/r-re/ching
effect upon the direction which subsequent theoretic/l development h/s t/ken.
It led to el/bor/tion of psycho-/n/lytic theory of the ego by Freud's heirs—
p/rticul/rly Ann/ Freud, H/rtm/nn, Kris, Loewenstein, Spitz, J/cobson,
M/hler, /nd Green/cre—/nd ch/nged pyscho-/n/lysis from /n id-psychology
to /n id-ego psychology, with the ego becoming more /nd more the focus of
investig/tive consider/tion.
Before Freud thought of the ego /s / structur/l entity, he /lre/dy knew th/t
the ego, even though incompletely conceived /nd defined met/psychologic/lly,
is the medium through which psycho-/n/lytic ther/py oper/tes. Glover /nd
Fenichel emph/sized Freud's observ/tion th/t the ego is the only institution
which is /ccessible to the /n/lyst /nd which c/n be influenced by /n/lytic
intervention. It is the recipient /nd synthesizer of interpret/tions. Freud further
m/int/ined th/t the procedure of psycho-/n/lysis is of /v/il only when there is
/ rel/tively int/ct ego which c/n p/rticip/te in the /n/lytic t/sk. While we still
hold this view tod/y, one of the clinic/l fruits of gre/ter theoretic/l knowledge
/bout the ego—its structure, its development, its functions, its rel/tionship to
the other psychic institutions—is th/t we /re now /ble to utilize the very
technique of psycho-/n/lysis in the service of en/bling the ego to perform its
/n/lytic work.
Current rese/rch in ego development promises more precise knowledge /bout
p/thology resulting from development/l deficiencies. More effective di/gnostic
/nd ther/peutic procedures for the so-c/lled modified egos /re imminent.
Me/nwhile, however, ego psychology h/s /lre/dy contributed knowledge which
dict/tes el/bor/tion /nd modific/tion of tr/dition/l technic/l procedure, not
only for the more severe p/thologies, but for the so-c/lled int/ct egos /s well
—those p/tients whom Freud design/ted /s /n/lys/ble bec/use the ego w/s
equ/l to the /n/lytic t/sk.
This offers /n /dv/nt/ge over id psychology. The id psychologist h/d to rely
upon wh/tever ego the p/tient h/ppened to be /ble to bring to the /n/lytic
t/sk. The ego psychologist c/n eng/ge in the continuous /n/lytic pursuit of
strengthening /nd exp/nding the ego, remedying development/l shortcomings,
/iding neutr/liz/tion, /nd utilizing the /utonomous functions tow/rd higher
levels of integr/tion. Thus, the ego itself h/s become / m/jor focus of psycho-
/n/lytic tre/tment. While this h/s /lw/ys been true for the tre/tment of the
more disturbed p/tient, I intend to cl/rify how modific/tions in technique
suggested by ego psychology /re /lso now indic/ted in the tre/tment of the
p/tient with the so-c/lled int/ct ego.
!. The Need to Conceptu+lize Technique
In / reference to the interdependence of technique /nd theory, H/rtm/nn
comments th/t there is / l/g on the side of technique in th/t it tends to be
outdist/nced by theory. His theoretic/l contributions in this reg/rd, n/mely, the
concepts of prim/ry /nd second/ry /utonomy /nd the role of intr/systemic /s
well /s intersystemic conflicts /nd correl/tions in the development of the
individu/l, /re some of the theoretic/l formul/tions th/t h/ve not yet been
/dequ/tely reflected in technic/l procedures. P/rticul/rly, the utility of the
/utonomous ego functions in the /pplic/tion of psycho-/n/lytic procedures
needs el/bor/tion.
Kris, too, observed th/t the /dv/nces in ego psychology dict/te modific/tions
in technique. He /ttributed this m/inly to the f/ct th/t we /re no longer
s/tisfied to consider psychosexu/l m/tur/tion only. The development of ego
functions /nd of object rel/tions /re equ/lly import/nt.
Knight (1954) s/ys:

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… the &ttempts to build & cl&ssific&tion of ment&l disorders by linking &
cert&in clinic&l condition to e&ch level of libidin&l fix&tion h&s presented &
one-sided, libidin&l theory of hum&n functioning. This psycho&n&lytic
contribution h&s been of m&jor v&lue, but it needs to be supplemented
extensively with the findings of ego psychology which h&ve not, &s yet,
been sufficiently integr&ted with libido theory.
Thus /re indic/ted not only more el/bor/te methods of di/gnostic explor/tion
—dyn/mic/lly, economic/lly, /nd p/rticul/rly structur/lly—but /lso
modific/tions in technic/l procedure. It is recognized th/t such modific/tions
h/ve indeed crept into pr/ctice, /lthough they h/ve not been theoretic/lly
formul/ted nor system/tic/lly recorded in the liter/ture. Much is h/nded down
by word of mouth from supervisors to c/ndid/tes. A kind of folk-lore of
technique h/s evolved which, however, is insufficiently conceptu/lized. The
m/in purpose of this p/per is to record /nd conceptu/lize some of the
philosophic/l /nd pr/ctic/l innov/tions in technique which evolve logic/lly
from ego psychology /s we underst/nd it tod/y.
!. Theoretic+l Found+tions
Sever/l reviews of the development of ego psychology h/ve been undert/ken,
most not/bly by R/p/port, /nd this need not be rec/pitul/ted here. I will
mention, therefore, only those concepts which h/ve /n immedi/te be/ring on
the ide/s presented in this p/per. I refer princip/lly to H/rtm/nn's concepts of
the conflict-free /re/ of the ego /nd of /d/ptive functioning; to Green/cre's
concept of /utonomy; to M/hler's observ/tions reg/rding the symbiotic /nd
sep/r/tion-individu/tion ph/ses of development; to J/cobson's theories
concerning self /nd object rel/tions.
Fund/ment/lly, the theoretic/l conclusions from ego psychology which le/d to
the technic/l modific/tions which will be discussed in this p/per c/n be
summed up /s follows. The ego, p/rticul/rly in its conflict-free sphere,
develops /t /n inn/tely determined r/te if the environment provides /dequ/te
opportunity for such development /nd, simult/neously, for the differenti/tion of
self /nd object represent/tions. Thus, there must be / ph/se-specific qu/lity
in the mothering which fosters optimum development in the child. In its direct
implic/tions for technique, one of the most outst/nding f/cts th/t h/s emerged
from rese/rch in ego psychology is th/t the individu/l is likely to develop
unevenly if the ph/se-specific mothering is in/dequ/te, /nd th/t this uneven
development occurs not only with reg/rd to the well-known overl/pping of
psychosexu/l ph/ses, but in two other respects /s well, n/mely, (i) ego growth
/nd differenti/tion between self /nd object represent/tions do not necess/rily
proceed in unison with psychosexu/l development; /nd (ii) within the ego itself
there m/y be uneven development /mong the v/rious ego functions. Thus,
tr/um/ is now understood /s occurring /t / given psychosexu/l ph/se when
the intern/l structure of the ego, the development of its functions, its
rel/tionship to the other psychic institutions, /nd the degree of object rel/tions
which obt/in, /re /ll decisive in determining wh/t resources the individu/l h/s
/v/il/ble for meeting the crisis. Psychosexu/l development m/y itself become
tr/um/tic if it proceeds before the ego is /ble to cope with it.
Since we know th/t the period of life usu/lly referred to /s the or/l ph/se is so
cruci/l for ego growth /nd for the development of fund/ment/l rel/tionships to
self /nd object, /ny one of the /lmost infinite combin/tions of possibilities for
in/dequ/te development in these /re/s results in imp/ired /bility to m/ster the
next period successfully. Spitz h/s demonstr/ted how the vicissitudes of one
ph/se of development determine the psychic equipment which is /v/il/ble to
the individu/l /t the next ph/se. Green/cre, in / complement/ry contribution,
h/s ex/mined how the /bility to m/ster tr/um/ is determined by the level of
ego development which existed /t the time of the tr/um/tic event.
Ego psychology /lso offers more profound /nd me/ningful criteri/ for
di/gnosis, /nd p/rticul/rly for ev/lu/tion of /n/lys/bility. It is no longer v/lid
to reg/rd / person who h/s re/ched, let us s/y, the ph/llic ph/se /nd is
gr/ppling with oedip/l conflicts, /s necess/rily the most tre/t/ble. Much
depends on whether ego growth /nd object rel/tions h/ve kept re/son/ble
p/ce with psychosexu/l development. The me/ning of borderline psychosis
/nd psychosis proper /lso t/kes on more dimensions /s we consider wh/t
these situ/tions me/n in terms of the vicissitudes of the development of the
ego in its intern/l structure /nd in its rel/tion to id, superego, /nd the outer
world; /nd in terms of the in/bility of the in/dequ/tely developed ego to de/l
with psychosexu/l development /nd to m/ster tr/um/.
The Role of the An&lyst. Most /n/lysts /gree with Freud th/t, essenti/lly,
technique is unte/ch/ble in its specifics, nor c/n m/ny rules be promulg/ted.
The essence of wh/t is te/ch/ble

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is /n /ttitude or philosophy b/sed on psycho-/n/lytic theory of person/lity
development /nd of the p/thologic/l consequences of the hum/n condition.
From this, technique flows n/tur/lly. One of the questions with which this
p/per is concerned is wh/t this philosophy is /nd how to /pply ego
psychologic/l findings to technic/l decisions. Green/cre (1954) provides /
most useful philosophic/l guide in her concept of the /n/lyst's concern with
the p/tient's /utonomy. She describes how the /utonomy of the p/tient is best
protected when /ctive procedures on the p/rt of the /n/lyst /re scrupulously
/voided. The inf/ntile neurosis, for which the p/tient seeks tre/tment, m/y, if
we /re not c/reful to gu/rd the p/tient's /utonomy, be repl/ced by
dependence on the /n/lyst, resulting in / p/thologic/l st/te which c/n become
even more powerful th/n the origin/l neurosis. This dem/nds / re-ev/lu/tion
of the tr/dition/l /n/lyst-/n/lys/nd role.
I sh/ll de/l first with the role of the /n/lyst, which is prim/rily th/t of
interpreter. Interpret/tion, however, if it is performed by the /n/lyst /s /n
exclusive function of his ego, m/y be too /ctive /nd, therefore, in Green/cre's
sense, d/m/ging to the p/tient's /utonomy. The growth-promoting function of
the /n/lyst requires th/t he relinquish some of his function of interpreter /nd
help the p/tient /rrive /t his own interpret/tions whenever possible. Kris
(1951) thinks th/t this will promote ego growth, diminish the /n/lyst's
omniscience, /nd p/ve the w/y for ultim/te independence. He /dvoc/tes th/t,
r/ther th/n interpret for the p/tient, the /n/lyst should substitute / question
designed to stimul/te the development of the p/tient's own interpret/tive
skills. The synthetic /nd integr/tive functions of the ego /re thus exercised
with the encour/gement of the /n/lyst. If the p/tient is slowly educ/ted to
such procedure /t the outset of /n/lysis, it c/n become / powerful /lly in the
termin/l ph/se when the independence of the p/tient is put to the test. The
/n/lyst must be const/ntly /lert to the p/tient's incre/sing skills, must convey
/n /ttitude of welcoming their emergence, /nd must be re/dy to relinquish the
exercise of his own skills even though the p/tient m/y perform less eleg/ntly.
The Role of the P&tient. I w/nt to discuss, first, the role of the p/tient in the
hypothetic/lly ide/l c/se in which the ego is c/p/ble of performing its
/ssigned t/sk of providing /n/lytic m/teri/l. It is evident, of course, th/t this is
not / single t/sk, but / combin/tion of sever/l, /s follows:
1. In order to be /ble to cooper/te with /n/lytic procedure, which brings no
immedi/te rew/rd, the 'reli/ble' ego must be one which c/n postpone
gr/tific/tion.
2. It must exist in conjunction with /n /bility to identify with the /n/lyst /nd
to work tow/rd / mutu/l go/l. In other words, / degree of object rel/tions
must obt/in in which identific/tion is possible.
3. It must be c/p/ble of dividing itself into experiencing /nd observing
p/rts in order to enter into the ther/peutic /lli/nce.
4. It must be c/p/ble not only of cooper/tion with the /n/lytic procedure,
but of synthesizing /nd integr/ting interpret/tions.
5. Since /n/lysis is c/rried out in / st/te of regression, it must be possible
for regression to t/ke pl/ce in the service of the ego, i.e. under its control.
6. It must be c/p/ble of utilizing verb/liz/tion r/ther th/n /cting out.
In other words, we /re t/lking here /bout / well-developed ego in /n individu/l
who is c/p/ble of / r/ther high degree of object rel/tions.
!. Technique in Cl+ssic+l Neurosis +nd Neurotic Ch+r+cter
As one might /nticip/te logic/lly, ego psychology h/s given us gre/ter insight
into defence /nd, from the /ngle of technique, therefore, more underst/nding
/bout the h/ndling of resist/nce. It /lso contributes to gre/ter respect for
/d/pt/tion /nd non-conflictu/l functioning. As H/rtm/nn h/s shown, the s/me
defence which m/y oper/te /s / resist/nce in /n/lysis m/y /lso serve the
function of prim/ry /utonomy. Therefore, /n/lysis of resist/nce must t/ke into
/ccount /spects which /re /d/ptive (i.e. which do not utilize counterc/thectic
energy) /nd which should, therefore, be left int/ct or even reinforced.
Resist/nce /n/lysis must be conducted in / w/y th/t does not throw out the
b/by with the b/thw/ter. The technic/l innov/tion suggested by Kris in this
reg/rd revises previously held views th/t /n/lysis /ims /t r/pid uncovering of
/n id content to which resist/nce b/rs the w/y. We now prefer to help the
p/tient underst/nd his defensive structure. When such structure is /dequ/tely
/n/lysed, insight follows with minim/l /ctivity on the p/rt of the /n/lyst
bec/use the synthetic /nd integr/tive functions of the ego /re /ble to t/ke
over upon the crumbling of / resist/nt structure.
The few clinic/l ex/mples which follow /re not

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designed to cover /ll /spects of the philosophy of technique which I /m trying
to convey here. The clinic/l illustr/tion of every point would require endless
ex/mples /nd would le/d to endless dispute over whether e/ch ex/mple does
indeed de/l with the point. I sh/ll, however, /ttempt to convey the fl/vour of
the ego psychologist's /ttitude /nd /ppro/ch.
The first of these de/ls with /utoerotic /ctivity which h/s been tr/dition/lly
understood /s serving instinctu/l /ims. Ego psychology in no w/y refutes this,
but does /dd /nother dimension. There /re indic/tions th/t /utoerotism /lso
serves ego exp/nsion, differenti/tion of self-represent/tions from object
represent/tions, /nd the est/blishment of identity. Thus, interpret/tion of
/utoerotic /ctivity /nd the f/nt/sies /ccomp/nying it m/y be incomplete /nd
m/y especi/lly be incorrectly timed if it /dheres to the one-dimension/l /spect
of id interpret/tion only. Esc/lon/ (1963) h/s shown th/t, /s e/rly /s four
months, the inf/nt eng/ges in /ctivity such /s rocking /nd explor/tion of the
body surf/ce which provides / beginning sense of self sep/r/te from the
mother. Spitz (1962), studying somewh/t older children, found th/t the non-
/chievement of m/sturb/tion /t the /ge-/dequ/te level is indic/tive of /
defect in object rel/tions. Thus, /utoerotism, whether m/sturb/tory or pre-
ph/llic, serves import/nt ego-building purposes. At the ph/llic level,
m/sturb/tion serves the purpose of reinforcing the successes of the
sep/r/tion-individu/tion ph/se, bec/use it provides /n /venue for gr/tific/tion
of / powerful instinctu/l dem/nd without dependence on the object. It is /lso
signific/nt th/t m/sturb/tion is c/rried on /s / secret from the prim/ry object,
thus reinforcing sep/r/tion by providing / sense of person/l priv/cy.
R/ther th/n restrict /n/lysis of m/sturb/tory /ctivity to /n/lysis of the
f/nt/sies, it h/s been found th/t / thorough investig/tion of the onset of
m/sturb/tion c/n bring rew/rding inform/tion reg/rding object rel/tions. An
inquiry into how m/sturb/tion w/s initi/ted c/n tell much /bout whether the
p/tient h/d /chieved sufficient initi/tive, possession of his body ego, sense of
identity, /nd sep/r/tion from the m/tern/l object to h/ve discovered w/ys of
gr/tifying himself. It is / clinic/lly observ/ble f/ct th/t, reg/rdless of the
strength of the drive, unless these conditions /re met, m/sturb/tion is
inhibited. If initi/tion h/s been by /nother person, usu/lly / pl/ym/te, then the
'w/iting' to be initi/ted is indic/tive of insufficient sep/r/tion from the prim/ry
object. In the extreme c/se, m/sturb/tion is never undert/ken bec/use there is
no sep/r/tion /nd /ll gr/tific/tion must proceed from the object.
For ex/mple, / young m/n who lives with his mother /nd is so closely tied to
her th/t she /lw/ys knows wh/t he is thinking, h/s / dre/m /bout touching. He
/ssoci/tes to m/sturb/tion /nd is immedi/tely thrown into /n /nxious st/te
bec/use, /ccording to his comments, even the thought of such /ctivity implies
th/t one c/n do things for onself /nd this renders mother less necess/ry.
Another ex/mple is th/t of / forty-ye/r-old profession/l m/n in /n/lysis
bec/use he is concerned /bout his in/bility to m/rry. He functions moder/tely
well in his profession, /lthough he fe/rs promotion. This set of circumst/nces
suggests typic/l neurotic oedip/l /nd c/str/tion conflicts—/nd these /re
indeed this p/tient's b/sic problems. Despite the preponder/ntly neurotic
picture, this p/tient did not m/sturb/te in childhood. This inform/tion showed
th/t the oedip/l problem w/s burdened by the sh/ky underpinning of
incomplete sep/r/tion from the pre-oedip/l mother. M/sturb/tion w/s
inhibited bec/use the sep/r/tion-individu/tion process h/d not proceeded to
conclusion. In such / c/se, it would be technic/lly incorrect to interpret first
from the side of the id. The correct first interpret/tion focuses on the
sep/r/tion /nxiety. This frees the ego to proceed with the forw/rd thrust th/t
h/d been blocked in childhood.
I sh/ll discuss one more c/se on the neurotic side before proceeding to the
discussion of technique /s it /pplies to the more disturbed p/tient. Very
roughly, we c/n m/rk the threshold of the sep/r/tion-individu/tion ph/se /s
the point where the inf/nt begins, psychologic/lly, to become /n individu/l in
his own right. Since this very cruci/l ph/se of ego development corresponds
roughly with the /n/l ph/se, p/rticul/r technic/l problems with reg/rd to the
/n/l p/tient /re illumin/ted by ego psychology. The /n/lly fix/ted p/tient is
ch/r/cteristic/lly un/ble to free-/ssoci/te, to p/y, /nd in other w/ys to
cooper/te with some of the b/sic /n/lytic requirements. Ego psychology
exp/nds our underst/nding of the me/ning of the silence, stubbornness, /nd
withholding, of such p/tients.
In our society, the period of ego exp/nsion, sep/r/tion-individu/tion,
/cceler/ted dem/rc/tion of ego bound/ries, distinction between self /nd
object represent/tions, tr/nsition of erotic zone from mouth to /nus, /lso
corresponds to

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the period of toilet tr/ining /nd the onset of speech. Appreci/tion of wh/t /ll
this me/ns /s / gest/lt to the developing individu/l suggests techniques for
en/bling the /n/l p/tient to /cquire the /bility to /bide by the b/sic rule.
Let us first try to underst/nd wh/t h/ppens development/lly /nd then illustr/te
with / clinic/l ex/mple. The psychosexu/l /spect is cle/r in th/t there is /
tr/nsfer of zones. If the or/l ph/se h/s been more gr/tifying th/n otherwise,
the child h/s / more or less firm st/rt tow/rds object const/ncy, h/s m/de /
good beginning tow/rd distinguishing self-represent/tions from object
represent/tions, h/s begun to use his /w/reness of self to exp/nd tow/rd
other th/n the prim/ry object, h/s begun to m/ster cert/in skills, p/rticul/rly
motility /nd the beginnings of speech, /nd h/s le/rned the v/lue of the word
'no' /s being threefold: (i) /s /n opportunity for identific/tion; (ii) /s / ch/nnel
for /ggression; (iii) /s / reinforcement of sep/r/tion. In such / clim/te, toilet
tr/ining is begun. The /bility to distinguish between self /nd object is t/xed to
the utmost /s the loss of f/eces is equ/ted with object loss /nd c/str/tion. At
the s/me time /s toilet tr/ining, m/stery of verb/l skills is undert/ken,
involving for the ego the complex process of symboliz/tion. The child is often
prodded to s/y / cute word /s well /s to def/ec/te on extern/l dem/nd. He
must /lso le/rn to withhold, however, bec/use def/ec/tion must be controlled.
An /n/lly fix/ted p/tient, therefore, comes to /n/lysis h/ving /cquired in
childhood / r/ther complex skill which /ppe/rs m/nifestly /s withholding.
Bec/use of the proximity of speech /nd toilet tr/ining, it /ppe/rs to his
unconscious th/t he is being /sked to undo wh/t his ego h/s e/rlier /chieved
in g/ining sphincter control when he is told to free /ssoci/te.
For ex/mple, / p/tient whose /n/l fix/tion w/s reinforced by p/rent/l
/dministr/tion of enem/s during the l/tency ye/rs is typic/lly silent in /n/lysis.
She verb/lizes sufficiently to st/te th/t free /ssoci/tion feels like loss of
control. The /n/lyst gives recognition to the f/ct th/t control is indeed / de/rly
won possession. This p/ves the w/y for interpret/tion th/t thoughts, words,
feelings, /nd f/eces /re often equ/ted /nd must, therefore, /ll be withheld.
Such interpret/tion often m/kes it possible for the /n/l p/tient to /ssoci/te
more freely /s the ego thus distinguishes. In this c/se, however, bec/use the
p/rents, by /dministering enem/s, robbed her of /n import/nt ego function
which e/rlier she h/d been encour/ged to /cquire, more /n/lytic work w/s
needed. After the ego's /chievement h/d been /cknowledged in order to
support the highest level of development, the speech f/ctor becomes the focus
of /n/lytic /ttention. This is true second&rily bec/use of the development/l
coincidence of speech /nd def/ec/tion /nd of the consequent tendency to
equ/te them in the unconscious, but prim&rily bec/use this p/tient h/d
le/rned to use silence to m/int/in /nd restore the ego's origin/l /chievement
of withholding. After such /n/lytic /ttention to the ego /spects, the instinctu/l
gr/tific/tion becomes /n/lys/ble in the tr/dition/l w/y.
The tr/dition/l view of such beh/viour /s resist/nce c/lls for review.
Resist/nce, by definition, is directed /g/inst / drive. In this inst/nce, however,
the silence h/s the purpose of protecting the ego /t its highest level of
/chievement. The p/tient, by silence, fights for the integrity of her ego in the
/n/lysis just /s she fought the onsl/ught of the enem/s. The correct technic/l
procedure is interpret/tion of this f/ct. The defences /g/inst the drives /re
/lso to be understood /nd interpreted /t the proper time. However, th/t c/n
come only /fter the correct ego interpret/tion is m/de.
The ego psychologist pl/ys on two violins, /lw/ys working with the ego to bring
it to the highest level of functioning so th/t it will be equ/l to the /n/lytic t/sk
of de/ling with the drives.
These clinic/l ex/mples illustr/te some of the re/sons /nd show how the
techniques dict/ted by ego psychology /re indic/ted even in c/ses where the
ego is f/irly int/ct /nd 'reli/ble' for /n/lytic work.
!. Implic+tions for Technique in the Tre+tment of the More Disturbed
P+tient
The second m/jor m/tter th/t I w/nt to de/l with concerns technique in those
c/ses in which the ego is somewh/t diminished in 'reli/bility' /s I h/ve defined
th/t term here, n/mely, /s reflected in its /bility to perform the /n/lytic t/sks. I
list these t/sks briefly:
1. Ability to postpone gr/tific/tion.
2. Ability to identify with the /n/lyst.
3. Ability to perform the ther/peutic 'split'.
4. Ability to synthesize interpret/tions.
5. Ability to control regression.
6. Ability to verb/lize r/ther th/n /ct out.
As /lre/dy mentioned, current rese/rch promises gre/ter knowledge /bout the
structur/l

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rel/tionships in borderline phenomen/. Alre/dy, contributions from these
sources h/ve n/rrowed the g/p between the neurotic /nd the more disturbed
p/tient so f/r /s /n/lys/bility is concerned. J/cobson's (1964) explor/tions of
structur/l rel/tionships in the more disturbed configur/tions /re pertinent here.
Of p/rticul/r interest is her concept of n/rcissism, which /mends Freud's view.
J/cobson points out th/t in the primitive psychic org/nism, prior to the
discovery of self /nd the object world, investment of libido in the ego is h/rdly
possible.
The technic/l suggestions I /m /ble to present with reg/rd to c/ses in which
some of the /bilities to perform the /n/lytic t/sk /re l/cking /re not
qu/lit/tively different from those /lre/dy indic/ted in rel/tion to the so-c/lled
'reli/ble' c/ses. From the qu/ntit/tive point of view, however, it is even more
necess/ry to keep / di/gnostic eye open for uneven development /nd to de/l
with the ego side first. It h/s to be remembered th/t I /m /ttempting to convey
/ philosophy of technique r/ther th/n / set of fixed instructions. In gener/l,
then, in order to prep/re the p/tient for /n/lytic work when he is deficient in
one or more of the requisites, it is necess/ry to seek out those /re/s where
/rrest in ego development is p/tent. The technic/l procedures involve:
1. Support of the highest level of development which h/s been re/ched.
2. Interpret/tion of the origin/l h/mpering situ/tion which impeded
development.
To t/ke /n ex/mple, / young wom/n in her e/rly twenties c/me for tre/tment
/fter h/ving m/de / suicide /ttempt when the p/rents divorced. In the child's
development/l ye/rs, the mother h/d subjected her to / series of nurses who
were dismissed without reg/rd for the child's developing object rel/tions.
Simil/r str/in on the growing child's /bility to form object rel/tions w/s
produced when, /s she beg/n to recognize the f/ther, the mother interpreted
the oedip/l wish. Thus, superfici/l knowledge of psychology w/s employed by
the mother to gr/tify her own symbiotic wish, to prevent the child's object
world from exp/nding, /nd to prevent repression.
These problems bec/me re/ctiv/ted ye/rs l/ter when the p/rents divorced,
plunging this very confused post-/dolescent into / p/nic over re-emerging
oedip/l wishes in conflict with strong symbiotic wishes. The only solution
seemed suicide, which represented symbiotic reunion. The suicide /ttempt
fortun/tely f/iled /nd the p/tient sought tre/tment.
The p/tient insisted, /t first, th/t, bec/use of the mother's pench/nt for
/m/teur psycho-/n/lysis, no interpret/tions should be m/de. On the f/ce of it,
this seemed logic/l, but only in the sense th/t if one thing is /n error then its
opposite is correct. The mother's interpret/tions were d/m/ging bec/use they
did not promote sep/r/tion /nd growth. In tre/tment, therefore, interpret/tion
is not to be /voided, but correct procedure c/lls for ego interpret/tion first.
This provides necess/ry ego building before the /ggression tow/rd the mother
/nd the oedip/l wishes c/n be de/lt with in / w/y th/t would le/d to resolution
r/ther th/n to p/nic /nd suicide.
Ego building work in the so-c/lled borderline c/tegories is commonpl/ce.
However, more precise underst/nding of its theoretic/l justific/tion c/n le/d to
newer /venues of /ppro/ch /long correct theoretic/l lines. There is much
empiric/l experiment/tion with tre/tment of borderline phenomen/ which does
not present opportunity for theoretic/l cl/rity. Only precise underst/nding of
wh/t t/kes pl/ce met/psychologic/lly contributes to the scientific core of
psycho-/n/lysis.
In the c/se under discussion, ego building consisted of improving re/lity
testing so th/t the fe/r of wishful thinking receded in import/nce; /nd in the
building up of st/ble object rel/tions through interpret/tion of the tr/um/tic
dis/ppe/r/nces of the nurses. The p/tient's fe/r of h/ving her mind re/d w/s
de/lt with by me/ns of interpret/tion of the symbiotic wish. Intuitive
interpret/tion, while never desir/ble bec/use it deprives the ego of opportunity
to work in the /n/lysis, is p/rticul/rly to be /voided in such / c/se bec/use it
/lso counter/cts sep/r/tion-individu/tion /nd incre/ses the fe/r of the
omniscient symbiotic figure.
Kris's technique of encour/ging the p/tient to m/ke interpret/tions is most
v/lu/ble in such / c/se. It c/n become / spir/l in which the ego exp/nds
bec/use it c/n do something for itself /nd in which the very correctness of the
self-interpret/tion le/ds to higher levels of integr/tion.
In the interest of promoting /utonomy, this p/tient w/s /lw/ys given the
freedom to withhold free-/ssoci/tion /nd dre/ms until the ego bec/me
c/p/ble of genuine volition. Not until the /bility to s/y 'no' is well est/blished
c/n one /lso s/y 'yes' without loss of /utonomy.
Thus, ego psychology provides more profound

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theoretic/l cl/rific/tion /nd gre/ter procedur/l precision to the well-known
ther/peutic ende/vours to support the ego /nd to /id repression in the
disturbed p/tient. Some such p/tients become /n/lys/ble in the cl/ssic/l
sense /fter the sep/r/tion-individu/tion crisis is m/stered /nd the ego h/s
h/d /n opportunity to exp/nd. In this p/rticul/r c/se, support w/s given to the
highest level of ego development—n/mely, the strivings for individu/tion /nd
for object rel/tions in /ddition to the prim/ry object—/nd, /t the s/me time,
the force blocking growth—the symbiotic wish—w/s interpreted. The highest
psychosexu/l level, which h/d out-dist/nced the ego, then bec/me /men/ble
to /n/lysis by / stronger ego th/n existed in the inf/ntile period.
Ego psychology contributes to technique /nd to the /n/lys/bility of cl/ssic
neurotics, neurotic ch/r/cters, /nd the more disturbed p/tients in still /nother
w/y. Kris points out th/t knowledge /bout child development en/bles the
/n/lyst to underst/nd /nd sometimes to reconstruct wh/t h/s prob/bly
h/ppened in / p/rticul/r p/tient's e/rly life, even though m/teri/l h/s not been
presented by the p/tient directly. One of the specific be/rings such knowledge
h/s upon technique is th/t it m/kes possible the interpret/tion of pre-verb/l
experiences. This is /ccomplished by the /n/lyst's /lertness to the repetition
of pre-verb/l tr/um/ in the tr/nsference.
For inst/nce, / p/tient is kept w/iting by the /n/lyst, or thinks he is. He enters
the consult/tion room in gre/t /nxiety. The tr/dition/l interpret/tion would
refer to de/th wishes tow/rd the /n/lyst. This does indeed /pply. But
explor/tion of the f/nt/sies th/t occurred while w/iting often brings m/teri/l
th/t m/kes for more precise interpret/tion of the ex/ct experience th/t led to
the /ggressive wishes in childhood. It m/kes possible the reconstruction of
pre-verb/l tr/um/, providing the ego with the possibility of m/stery. The
technique suggested for this purpose is to solicit the minute det/ils of the
f/nt/sy. Thus, whether you were there or /bsent; whether you h/d forgotten
the p/tient; whether you were h/ving sexu/l intercourse; whether you were
otherwise eng/ged /nd too busy to c/re /bout the p/tient; whether you were
/ngry with him for needing you, etc.; /ll offer clues which point to the ex/ct
n/ture of the origin/l tr/um/ /s revived in the tr/nsference.
Another p/tient, who suffers from function/l g/stritis, clings to predomin/ntly
neg/tive object represent/tions. The clinic/l picture is m/sochistic-like. The
impression is th/t, while object rel/tions /re indeed firmly est/blished, they /re
connected with unple/s/nt e/rly experience with /n /ggressive, unloving
mother. The precise n/ture of this e/rly tr/um/ w/s cl/rified when the p/tient
reported th/t one evening, when depressed, he h/d w/nted to telephone the
/n/lyst. However, he decided /g/inst it. Det/iled questioning /bout wh/t went
into this decision w/s the technique which led to underst/nding much /bout
e/rly feeding experiences. The next thought /fter the wish to telephone w/s
th/t the /n/lyst would be imp/tient with him, would rush him, would h/ng up
the telephone if he could not s/y wh/t w/s on his mind quickly enough. Here
we find the repetition of hurried /nd uns/tisfying feedings. The p/tient w/s
/sked whether he is in the h/bit of e/ting quickly. He w/s not /t /ll surprised
/t the question /nd w/s /ble to connect his current /ttitudes with the genetic
experience /nd to underst/nd more /bout his 'loy/lty' to the neg/tive prim/ry
object.
As it becomes more /nd more possible to conceive of /n/lysis /s the ther/py
of choice for p/tients somewh/t more disturbed th/n the cl/ssic/l neurotic,
some of the technic/l pitf/lls /lso come into focus. One is th/t we c/nnot so
re/dily t/ke for gr/nted the genuinely volunt/ry n/ture of compli/nce with
/n/lytic procedure, bec/use the more imp/ired ego is not yet c/p/ble of such
choice. In Spitz's (1957) terms, the p/tient is not yet c/p/ble of s/ying 'no'.
Another is th/t the uneven development presents qu/ntit/tively gre/ter
problems in the more disturbed p/tient /nd, therefore, requires more
ther/peutic /ttention. A third difficulty is th/t imp/ired object rel/tions m/ke
for / more difficult, /pp/rently n/rcissistic tr/nsference. Still /nother is the
e/se with which the tr/nsference neurosis c/n become re/l to the p/tient
whose re/lity testing is poor.
!. Termin+tion
An/logous to Eissler's ide/l model of technique, the ide/l model for termin/tion
should be th/t m/jor conflicts h/ve been interpreted, worked through /nd
resolved; m/jor defences which do not serve /d/ptive go/ls h/ve been
/b/ndoned; blocks in the p/thw/y of the ego's inn/te tendency to thrust
forw/rd h/ve been understood /nd m/stered; the tr/nsference neurosis h/s
been utilized for ther/peutic purposes /nd its intensity gr/du/lly /ttenu/ted;
the c/p/city for love /nd work /re under the

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domin/nce of /n exp/nded ego; /nd, on the pr/ctic/l side, the p/tient no
longer finds /ttend/nce purposeful nor feels the need for it. Of course,
termin/tion r/rely, if ever, comes /bout so smoothly. Nevertheless, this model
c/n be most closely /pproxim/ted if the seeds of the end go/l h/ve been sown
/t the outset. If the p/tient's /utonomy h/s been so respected /nd promoted
th/t he becomes incre/singly independent /s /n/lysis proceeds, the termin/l
ph/se tends to develop n/tur/lly.
The /pp/rent contr/diction, of course, is th/t in the process of /n/lysis, we
wish to elicit the full force of the p/tient's dependency, often even h/ving to
/n/lyse defences /g/inst it. However, it is precisely bec/use we do this in /n
/tmosphere of simult/neous gu/rdi/nship of /utonomy th/t the full intensity of
tr/nsference, no m/tter wh/t its form, need not be fe/red. The dr/m/ c/n be
pl/yed out to the fullest extent bec/use the /n/lyst does not p/rticip/te in it
/s / re/l figure /nd does not do too much for the p/tient. Such reg/rd for
/utonomy obvi/tes the need for some of the desper/te devices sometimes
/dvoc/ted. Thorough underst/nding of the process of sep/r/tion repl/ces
such me/sures /s enforced time-limits, t/pering off, /ltering the frequency of
the sessions, etc. The sep/r/tion process is best /ccomplished vi/
interpret/tion r/ther th/n devices. If devices do h/ve to be used to /ugment
interpret/tion, then they should be t/ilored to the individu/l sep/r/tion conflict
which h/s been understood in the course of the /n/lysis. Only then c/n the
/rr/ngement /void constricting the ego, bec/use it will necess/rily be devised
to undo the origin/l block/ge /nd to rele/se the p/tient to live in /s much
freedom /s is possible in the hum/n condition.
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