30 minute read

Kenneth A. Frank The Evolution of Paul Wachtel’s Integrative Psychoanalytic Vision

especially in the West, are treated in institutions, whether in the mental health industrial complex or the prison industrial complex. So we could ask ourselves what kind of salutary role psychoanalysis could play in these cases. This summer, I heard a fascinating seminar about psychoanalytic work done with mentally ill patients locked in the Broadmoor High Security Hospital in the UK for having committed inexplicable violent crimes. It was inspired by the clinical work of Leslie Sohn on psychosis and violence. Unlike New York City Mayor Eric Adams, who wants to enforce psychiatric treatment on those unhoused individuals who, as he claims, pose a danger to themselves and others, Sohn used psychoanalysis to understand better and help those who, due to their psychotic illnesses, have committed seemingly unprovoked assaults.

This British tradition suggests that psychoanalysis is at its best when it emphasizes the development of responsibility to others before and above anything else. This lies at the heart of the Kleinian understanding of the shift from the paranoid-schizoid kind of power relations—call it politics, if you want-to the depressive one, in which one takes responsibility for one’s inevitable aggression as it makes efforts to repair the damages caused to the object. In that sense, I think it’s great that people with expertise from experience organize and share their knowledge with psychoanalysts and scholars. I believe that being part of such a group or a mission is meaningful and could have a curative effect in and of itself. I also think that there are many good options for those seeking treatment for Serious Mental Illnesses (SMI) other than psychoanalysis and that are nonetheless far more comprehensive and effective than the reductionist psychopharmacological regimen patients are subjected to. A case in point is the Finnish Open Dialogue treatment. But being aware of all of these alternative forms of treatment does not, all by itself, change the way I listen to individuals who come to me for psychoanalysis or psychoanalytically informed psychotherapy. As a psychoanalyst, I listen to the individual and the more infantile, primary layers of their mind provoked by the transference relations.

Part of my training as a psychoanalyst was almost two years of infant observation, which continued in a minimal but meaningful way once a year for the last ten years. When I work as a psychoanalyst, I remain attuned to the infantile parts of the personality, psyche, or mind, to these early paranoid-schizoid phantasies and their depressive counterparts. I do it when I see very troubled patients, who, most of the time, would not even be able to advocate for themselves, let alone organize and demand institutional change, just as I do it when I work with patients who are otherwise high-functioning individuals, who would hardly get any diagnoses of mental disorder. In sum, the short answer to your question is that psychoanalysis always works with lived experience, to begin with of the individuals who seek our expertise as analysts who are trained to listen to unconscious phantasies as they are communicated verbally and non-verbally in the transference-countertransference relations. These relationships, as we know, have their own fraught ethical and political aspects, which we can hear and analyze in the hour, in whatever setting we end up meeting our analysands. z

The Evolution of Paul Wachtel’s Integrative Psychoanalytic Vision Kenneth A. FRANK

Accommodating to Covid, Paul Wachtel and I met online on a late January morning. In ways, the meeting reminded me of one of our lunchtime meetings at New York’s Café Fiorello over the years. Paul and I are friends, having met at first when I consulted with him about my growing interest in psychotherapy integration “from the analytic side,” in the mid-eighties.

Via Zoom, I started by asking Paul how he found his way to psychology. He chose to begin with his past as—of all things—an undergraduate physics major at Columbia University. For three years while earning A’s in math and science courses, he also experienced a growing sense that physics was not really what he wanted to devote his life to. But he did not have a clear sense of what alternative would really be his passion, and at the end of his third year at college, a sort of panic set in as he struggled to find his true vocation. He used the metaphor of a Ouija board to describe going to the college bookstore one day, almost in an altered state of consciousness, and just seeing what section he was “drawn to.” Thankfully for our field, it was Psychology.

At graduate school at Yale, Paul was exposed to the thinking of many analysts, including his mentor, Sidney Blatt; George Mahl, who taught psychoanalytic theory both at Yale and the Western New England Psychoanalytic Institute; Roy Schafer and Ernst Prelinger, with whom he had an intensive year-long seminar on psychoanalytic theory and practice; and a range of psychoanalytic psychiatrists at his internship at the Yale Psychiatric Institute. He found these psychoanalytic ideas, as well as the broader field of clinical psychology fascinating, but also felt a kind of “intellectual claustrophobia” that called on him to diversify his studies through outside study groups centering on literature, sociology, and social criticism. Intellectual confinement does not suit Paul.

As a psychoanalytic candidate at NYU Postdoc, Paul welcomed the range of views he was exposed to in the years before Postdoc split into separate “tracks.” He was particularly drawn to interpersonal psychoanalysis and its interest in the impact of the world around us and of the actual relationship in the room. John Dollard, Paul’s first therapy supervisor at Yale, had hoped Paul would go to the New York Psychoanalytic Institute, and one must wonder how that would have played out. (Paul suspects he would have dropped out after a year or so.)

For much of the time Paul was at NYU Postdoc, he was also a faculty member at NYU’s doctoral program and part of NYU’s psychoanalytically oriented Research Center for Mental Health, headed by George Klein and Robert Holt. At one point, Klein was invited to participate in a panel at APA addressing Walter Mischel’s critique of psychoanalytic thought. Klein was too busy and handed it off to Paul. Paul found some parts of Mischel’s critiques of psychoanalysis naive and misinformed, but in other respects his encounter with the research Mischel cited in his arguments, and especially, his first real encounter with behavior therapy, which up till then he had paid little attention to, was eye-opening. He was both impressed with the evidence that behavior therapy could in fact

create significant clinical change and not just “symptom substitution” and struck by ways in which these two seemingly incompatible theories and approaches could in fact be complementary and synergistic. These were new and surprising conclusions for him, and led eventually to his theory of cyclical psychodynamics, a revised understanding of the essence of psychoanalytic thought itself.

In later years, Paul’s integration of psychoanalytic and behavioral methods was paralleled by integrations with other approaches as well. At the time he was working on his first book, Psychoanalysis and Behavior Therapy: Toward an Integration, his wife, Ellen, was studying family therapy at the Ackerman Institute, and he began to see ways in which family systems theories intersected with his cyclical psychodynamic theory and in which family therapy methods could similarly enhance psychoanalytically oriented work. The result was a book, written with Ellen, called Family Dynamics in Individual Psychotherapy. In these same years, he wrote The Poverty of Affluence, a book of social critique that pointed to still further ways in which context needed to be taken into account in our understanding of individual experience. Around the same time, he was one of the co-founders of the Society for the Exploration of Psychotherapy Integration (SEPI), an international organization devoted to breaking down the barriers that keep therapists of different orientations from knowing each other’s work and learning from each other. Opportunities to interact with therapists from a wide range of views through SEPI have been a seminal influence on his thinking ever since.

Through all these developments, Paul credits as a major source of stimulation and encouragement, his membership on the faculty of the clinical psychology doctoral program at City College of New York, with its strong dual commitment to psychoanalytic thought and practice and to promoting social justice.

With this material as background, Paul and I referred to our list of questions.

KF: Paul, it seems that you came to psychotherapy integration and your central concept of cyclical psychodynamics—recognizing the mutual influence of the inner and outer worlds—quite early in your career. In ways, your ideas have evolved with the times, indeed have played a major role in shaping many of our newer ideas. Yet it strikes me that many of your most fundamental beliefs about the workings of personality and psychotherapy have remained quite consistent over the 50 years you’ve been publishing. Would you agree? the “loyalty trap.” I was brought up professionally essentially to think, “Psychoanalysis good, all else bad.” Those trained in other orientations mostly received the equivalent messages. To actually consider that behavior therapy had something to offer—that it could add something that psychoanalysis did not provide or that it could actually be compatible with a psychoanalytically inspired way of thinking and working—required a major leap. Respected mentors, supervisors, and colleagues referred not only to behavior therapy, but to the parallel emergence of family therapy, community psychology, and other developments as if they represented the invasion of the Visigoths. As a symptom of this binary “us-them” thinking, to this day I encounter some people in the psychoanalytic world who—thinking of it simply as descriptive—refer to me as a “behaviorist.” Not only does that characterization seem to erase what is still my primary identity, which is as an integrative psychoanalytic or psychodynamic thinker and therapist, but it actually misses the most central element in what I discovered as I studied behavior therapists closely—that very few of them were really behaviorists. As I have spelled out in a number of places, they are actually more phenomenological and introspectionist in their methodology than behaviorist. They are behavioral—that is, paying attention to our actual behavior in the world—but not behavioristic, which is an ideology that ignores subjectivity.

Once I made that leap—that an interest in and respect for other approaches did not contradict or weaken my psychoanalytic identity or understanding (though it of course modified my views of what is the essence of such an identity and understanding)—the rest did follow more smoothly and gradually. To this day, as I continue to examine and integrate new methods and perspectives, I build upon that initial leap, that rejection of the “us-them” foundation of our field. I also build on the cyclical psychodynamic perspective that first emerged in my efforts to integrate psychodynamic and behavioral methods. In that perspective, the key unit of analysis is the repeated cyclical patterns—both vicious and virtuous circles—that characterize the dynamics of personality and that link the past and the present in a way that does not downgrade the importance of either. This perspective aims to transcend binary distinctions between a “deep” internal world and relatively superficial “external” influences. It traces development in terms of how, from very early in life, the way we see things and experience things leads us to act in certain ways, and how, much of the time, the result is that we draw forth responses from other people that lead us to continue to see things and experience things in the same way. Most of this goes on unconsciously, but the unconscious needs to be understood not simply in terms of representations but, beyond that, with regard to how we live our lives. We do not live in an “inner world.” The feelings, perceptions, fantasies, desires, experiences of self and other— both conscious and unconscious—that have often been discussed in psychoanalytic discourse as “internal” are absolutely critical to my thinking. But they cannot be adequately understood without understanding them in relation to the continuing events and experiences of our lives and to the ways in which “inner world” and “outer world” are, to a very large degree, products of each other. I have used the metaphor of the Moebius strip to highlight the ways in which the “inner” is not “deeply buried,” in archaeological fashion but is inextricable from what we sometimes call the “outer.”

Using this foundation, my integrative efforts proceeded from behavior therapy, to family therapy, to a still broader range of experiential, attachment-focused, and mindfulness and acceptance-based approaches. This same foundation pointed as well to ways of integrating concerns about culture, race, ethnicity, materialism and a number of other factors that I again tried to rescue from earlier formulations that treated them as “external” and to instead understand them as critical elements of the very deepest reaches of the self. So yes, I have continued to build on the foundation that emerged from my first encounter with transcending the “us-them” definitions of what is psychoanalytic, but, like personality itself, my understanding has both stayed the same and changed with new experiences and challenges.

KF: If I may, Paul, I’d like to underscore and extend one important point you made— that knowing other modalities does not make one “less analytic,” as it were. Rather, by providing multiple lenses for viewing and understanding clinical phenomena as well as additional rationales and strategies for intervening, it allows one to become more analytically creative as a practitioner.

Now, I imagine you’d agree that over time, your ideas, which during the 70’s and 80’s I saw as visionary, have come to comport well with relational developments—Steve Mitchell’s relational synthesis, including interpersonal psychoanalysis, for example, and his notion of the “relational matrix” and subsequent relational developments.

PW: The early publications depicting the cyclical psychodynamic perspective predated the appearance of the earliest relational writings, but you are correct that cyclical psychodynamics is grounded on many of the same assumptions and reexaminations as Mitchell’s theory and as other relational perspectives as well. The overlap became increasingly apparent to me over time, and I now think of

cyclical psychodynamics as a version of relational thinking. Although I had formulated and published a version of the cyclical psychodynamic point of view as early as 1973, the first full scale elaboration of the theory and its implications was in my 1977 book, Psychoanalysis and Behavior Therapy: Toward an Integration. It was then extended to include family systems thinking in a 1986 book I wrote with my wife Ellen, called Family Dynamics in Individual Psychotherapy. When Steve Mitchell’s «Relational Concepts in Psychoanalysis» came out in 1988, I was struck by many ways in which his thinking was compatible with my own, even though there were also differences in emphasis, style, and content and although he had come to his ideas via a different path. As my own ideas continued to evolve, I increasingly also was attending to developments “next door,” so to speak, in the evolving relational movement. At some point along the way (I don’t recall what year), Lew Aron, who was then the head of the relational track at NYU postdoc, where I was already on the faculty, met with me to discuss my joining the relational track, since he felt my theoretical views were really a form of relational thought. I said yes and have been a member of the relational faculty ever since.

I had periodic discussions with Steve Mitchell about the similarities and differences in our thinking, and at one point invited Steve to participate with me on a panel at SEPI. This led, a bit later, to my asking Steve to join the advisory board of SEPI, since his thinking, albeit not so much focused on integrating psychoanalysis with “something else,” was quintessentially integrative. Steve accepted and served on SEPI’s advisory board for a couple of years, but then contacted me to step down because he felt that his efforts were so focused on integrations only within psychoanalysis that he did not want to spread himself thin by also addressing the kinds of further integrations SEPI was largely about. I understood Steve’s point, but also regretted his decision because he was one of the finest integrative minds I have known. Notwithstanding Steve’s resigning from SEPI, he and I stayed in touch, and—unfortunately, just a relatively short while before his untimely death—we were beginning to meet more regularly to discuss the convergences in our thinking. We were colleagues rather than friends, but we were greatly enjoying these exchanges, and the relationship seemed to be moving toward a real friendship when tragedy struck. I’ve thought often of what might have emerged from our conversations had Steve lived.

Apropos another (and related) part of your question, The concept of the relational matrix is indeed one of the most important links between the two lines of thought. I use that term and that concept frequently in my writing, and it is a key element in my thinking about what I call “the contextual self,” a term I use to elaborate on the ways that attention to early experiences and the intrapsychic can be integrated with attention to the ways we are also keenly responsive to subtle variations in the relational context. This was also an idea I discussed a number of times with Merton Gill, who I had gotten to know at the Research Center for Mental Health at NYU and at meetings of the Rapaport-Klein Study Group. I screwed up my courage and, on a long shot, asked Merton if he would read the manuscript of my first book, Psychoanalysis and Behavior Therapy, and consider an endorsement. I considered it a long shot, since at the time he was one of the most influential thinkers in psychoanalysis and I was still a young junior faculty member. I was grateful for his generosity in agreeing to consider it (Merton was not the kind of man who suffered fools gladly), and when he agreed to actually endorse the book, even though it raised questions about some of the positions with which he was still associated in the literature, I was not only grateful but impressed with his openness. I did not know at the time that his own thinking was beginning to evolve toward a two-person point of view (he had, earlier in his career, been one of the most articulate defenders of the one-person perspective), and I was struck, over the following years, how his and my thinking seemed to co-evolve, as we read each other’s work and had occasional continuing conversations about our common interests and evolving theoretical inclinations.

Over the years, I have continued to absorb, and be influenced by important thinkers in the relational tradition. These include, in a major way, your own thinking, which has been enormously stimulating to me both for its elaborations of relational theory and for its creatively integrative explorations of active interventions of a wide variety, all pursued from a sophisticated relational foundation.

KF: Thank you, Paul. So you’ve progressively expanded the model to include more approaches and also the determinative role of context, while anchoring it to the early cyclical psychodynamic approach. I understand that, but there is a point I have had trouble with in your thinking—one of very few; it is that some of your writings seem to imply an equivalence among early and later experiences. Of course, it is customary for analysts to see the early period as especially formative, and in recent years, in validating ways, we have learned from neuroscience and attachment research that the early years are a period of rapid brain growth and receptiveness to foundational implicit learning. These early family schemas are thought to be more enduring and less readily modifiable than most later learning. What are your thoughts about this?

PW: I agree, this is one of the places where my own version of psychoanalytic thought departs most from the views held by many analysts, including even some elements of the relational perspective with which I am in most ways in strong agreement. I do see early experiences as critically formative in many ways. But I diverge in two ways. The first, which you are familiar with, is more theoretical. It has to do with what I called the “woolly mammoth” model in my first book—the traditional psychoanalytic idea that repression and other kinds of defenses and splits seal off certain parts of the psyche from change, keeping them unchanging and “timeless,” “archaic,” “primitive,” “preoedipal,” what have you. This model of the unconscious as frozen in time, prevented from changing and growing up by the layers of defense under which the original “infantile” wish or fantasy is buried, reminded me of the stories of perfectly preserved woolly mammoths occasionally found buried under the Arctic ice, unaffected by everything going on the “surface.” (It was an image in part stirred in me by Freud’s comment that the repressed is not subject to the same kind of “wearing away” that consciously accessible thoughts and ideas are subject to.) This idea has been (without the mammoth per se, of course) a dominant image underlying most psychoanalytic perspectives. It was most explicitly spelled out in The Ego and the Id (again without the mammoth per se), but is evident in the full range of psychoanalytic perspectives that continues to describe functioning adults as preoedipal, as having a psychotic core, or in a range of other related concepts and metaphors with similar import. My own cyclical psychodynamic perspective does take into account the observations that have generated such ideas, but it explains those observations very differently. It sees those “infantile” or “archaic” elements not as the simple, direct, linear result of early experiences and psychological structures having been walled off from the impact of later ongoing experiences, but as the product of countless interactions throughout the life span in which expectations and skewed behavioral and emotional reactions elicit responses from others that generate still again the same expectations and skewed behavioral and emotional reactions. Put differently, the psyche develops not via a split off “primitive” part covertly influencing an only superficially adult part, but via a repeated series of vicious and virtuous circles, in which the primary consequence of our early experiences is to skew the kinds of later experiences we have. By the time the pattern replays itself (over and over) in our adult life, it is no longer simply the product of what happened early; it is the result of the entire (continually repeated) history.

Consider, as but one example, a patient (I’ll call him Edward) whose troubled mother needed constant, almost symbiotic, attention, who couldn’t let him grow up and grow apart, who felt betrayed and tended to decompensate when Edward had normal interest in spending time with friends or pursued his own interests. The tremendous guilt and inhibition (and unconscious rage) with which he lived was certainly initiated by his early developmental experiences. But over time, the primary engine of the pattern evident in his life lay not in the distant past but in the evolving present. His constant nagging sense that he was being disloyal, inattentive, neglectful, selfish (initially experienced with his mother, but also, over time, with friends and lovers) led him to experience each new relationship as a painful test of his worth as a human being that he would likely fail. He would at first try to be “everything” to the other, pushing himself to his limits and ignoring his own needs and feelings, but would still experience that the other person felt it was not enough. In part this derived from a selective perception that magnified (and often misinterpreted) even the slightest dissatisfaction with him by the other. But his perception of the other’s dissatisfaction with him generally also reflected something really going on—the other might not always be aware of or clear about much of what was happening between them, but at some level would sense Edward’s unacknowledged anger and resentment at what felt to him like an exhausting and one-way relationship and would experience Edward not as a generously attentive and responsive giver but as grudging and resentful in his giving, no matter how “much” of it there was. Indeed, often Edward’s excessive availability would elicit a negative response in its own right, feeling cloying even as Edward was feeling worn out. The relationship would, as a consequence, typically begin to feel like an arena in which Edward’s extreme sensitivity to even the slightest sign that he was being perceived as hurtful because he was not totally available and totally devoted became a source of great pain. The frequent consequence was that at some point, in order to gain some relief from that pain, he would withdraw to a rather extreme degree. This, in turn, once again stirred the old feelings (first communicated by his mother) that he was selfish, disconnected, and unable to relate to others. Then, in the next turn of the wheel (either with the same person or with a new figure in his life), he would respond to the painful feelings his withdrawal had stirred by once again being overly available and giving, and the cycle—most of whose elements were unconscious—would begin again.

This pattern, in my view, is insufficiently understood by explaining it as the product of his having “internalized” the messages of his early childhood. To understand it sufficiently—and especially to intervene effectively—it is essential to understand how it is the product of repeated experiences throughout his life, in which each step leads to the next in a repetitive cycle in which the primary engine is not how it started but how it is maintained over and over by the new experiences that are continually being generated.

The second reason I focus much of my effort on the present rather than the earliest experiences does not reflect a view that their impact is unimportant but rather is rooted in the difficulty in genuinely recapturing those experiences. Many of them are pre-

verbal, and even those occurring in the years when language has just begun to develop are difficult or impossible to recall. Experiences of enactment or other transference experiences are often thought to make them accessible, but it is my belief that we largely exaggerate the degree to which those occurrences really recapture these early experiences. When addressing enactments or transference reactions is therapeutically useful, it is largely because they reflect the current tendencies that were set in motion by the earlier experiences in the way I was discussing a bit earlier, not because they unearth something that has been stored in potentially accessible form for decades.

We work most effectively on how the person is living now. That is where we can have our impact. In doing so, I remain powerfully influenced by a psychoanalytic sensibility, with a central concern with the degree to which much of what we feel, what we seek, what we think, and even what we are actually doing in relation to others is obscured from our consciousness. But in employing that psychoanalytic sensibility, I aim to work with the unconscious processes that are currently shaping the patient’s life and to understand them in relation to the ongoing and often reciprocally interactive contexts in which they are manifested. That, it seems to me, is where our therapeutic leverage is likely to be greatest and most able to help the patient turn his life in a more satisfying direction.

KF: Thank you, Paul. That’s clarifying. So one of the ways in which you were visionary is that back in the 1970’s, you took a view, quite radical at the time, that emphasized the present over the past. That early theoretical shift affected treatment as you saw (and see) it and presaged a much later clinical trend in contemporary psychoanalysis.

Your reply leads me to wonder whether more recent theorizing about dissociation and trauma, especially “Big-T” Trauma, has impacted your thinking in any way. And, in a related vein, are there other recent developments you have not mentioned that have significantly influenced you?

PW: I have increasingly been interested in dissociation as a concept that illuminates, and to some degree reframes, a wide range of clinical phenomena. Freud’s turning away from the term, as a product of explicit and implicit competition with Janet over priority, was a significant misstep. It grounded psychoanalysis most of all in repression, which in turn made consciousness the key aim and criterion. Dissociation is a much broader concept (somewhat overlapping with but not reducible to the broader concept of defense in contrast to repression). Phenomena such as intellectualization and isolation—in which conscious verbal awareness, emotional experiencing of what one can talk about verbally, and the inclination to be moved to action on what is verbalized are all separated—are best understood as phenomena of dissociation, as are the different set of phenomena discussed these days in terms of multiple self-states. Freud, of course, did come to articulate this broader set of defensive efforts (without much reference to dissociation) through the path of (and as part of constructing) ego psychology. But the grounding of psychoanalysis in the concept of repression as essentially the Urdefense, largely rendered all the other kinds of defensive efforts as “additional,” as further means of bolstering repression. And this left analytic technique insufficiently active and experiential, too bound to the distinction between conscious and unconscious and to verbal awareness, and too dedicated to interpreting and uncovering. By referring to repression as the Ur defense, I don’t mean

…intellectualization and isolation—in which conscious verbal awareness, emotional experiencing of what one can talk about verbally, and the inclination to be moved to action on what is verbalized are all separated— are best understood as phenomena of dissociation…

that it comes first; much psychoanalytic theorizing, both from the repression framework and from the dissociation framework, points to a developmental sequence in which other kinds of defensive efforts occur earlier, and repression comes only after a significant degree of cognitive development. Rather, I mean that the metaphors in which psychoanalytic thought are cast (including the pervasive archaeological metaphors of uncovering, digging up, bringing to light, etc.) derive from Freud’s most fundamental interest in repression, in the hiding and disguising that give the analyst the opportunity to be clever in undoing the disguise. (Freud illuminated a wide range of ways in which we can defend against a threatening experience, but among these various kinds of defenses, repression was clearly his “favorite child.”) With dissociation as the grounding metaphor for defenses, the therapeutic aim of helping the person accept and experience and reintegrate that which has fearfully been cast off becomes more obvious, and a different grounding structure for psychoanalytically inspired therapeutic work becomes apparent. I’m working on a book now that explores these issues.

With regard to trauma, I think the rediscovery of trauma has been a very important development in psychoanalytic thought, but I also think that it is part of an even broader development, represented especially by attachment theory, of going beyond the emphasis on fantasy to acknowledge the impact of reality. Fantasies, idiosyncratic meaning-making, ways in which we are not merely responding in some one-to-one way to what is going on are critical to attend to, but for many years, reality retreated too far and fantasy loomed too large. Attention to trauma was, in the last few decades, an especially important path back to reintegrating reality into psychoanalytic thought and practice. But that reintegration should not be limited just to trauma.

KF: I look forward to reading your next book articulating these thoughts further. Finally, I know that SEPI, which you co-founded, has had enormous national and international influence and that psychotherapy integration has had a huge impact on the field. Yet I’m personally disappointed that, with few exceptions like N.I.P., most psychoanalytic training programs do not educate analysts in integrative work. Do you share my impressions and feelings? How do you understand these developments?

A related “intraprofessional” question also occurs to me. When I first became inspired by psychotherapy integration during the 80’s, I felt like a professional outlier. The staunch analysts (who formed a kind of narrow-minded elite at the time, in my view) were the card-carrying members of the profession. I felt somewhat stigmatized by my analytic colleagues when I openly proclaimed the value of Behavior Therapy, for example. Nowadays, I think I’m regarded less judgmentally and, I suspect, at least in my own circle of analysts, as being at the vanguard of an important development. What I’m getting at here is the long struggle for psychotherapy integration’s legitimacy within psychoanalysis. I wonder how you’ve experienced your own role in this regard. A sense of marginality?

KF: I think you’ve put your finger on an important issue and a major challenge. I too started out feeling marginalized by my explorations beyond the then standard boundaries of psychoanalytic thought and practice

(recall my earlier comment about being described as a behaviorist). And I too, like you, have subsequently seen my personal acceptance thrive. But I too have noted as well still predominant limits on what might be called “the integration of integration” into our field as a whole, a failure to appreciate that for psychoanalysis to survive, it must stop circling the wagons and open itself to developments outside its original boundaries. I think here we may see still another vicious circle. As CBT advocates have taken on the same kind of hegemonic arrogance that analysts exhibited in the 1950s, ‘60s, and ‘70s, current day analysts understandably recoil from their narrow-minded refusal to see what remains of great value in the analytic point of view. The result is that each side sees only the worst side of the other, the self-justifying, blindered side, and that feeds still further self-justification and exclusionary thinking. Institutes like NIP that try to go beyond those selflimiting dynamics are of great value, and of course SEPI keeps trying to foster real collaboration, dialogue, and (most important) mutual learning across the partisan divides. And I do think that I have seen considerably more interest among analysts in the broader range of therapeutic possibilities that exists today—not just with regard to cognitivebehavioral methods (especially in more acceptance- and mindfulness-based versions of CBT such as ACT and DBT, or in versions such as schema therapy) but with a range of other ways of thinking and working, such as family systems approaches, experiential and body-centered approaches, even approaches still largely identified as psychodynamic that are in their essence integrative, such as AEDP, control mastery theory, or the work of the Boston Change Process Study Group. And I think it is a very important development that psychoanalysis is increasingly taking into account the absolutely critical role of race, class, and culture in every phenomenon that psychoanalysis has attempted to address and understand. I think the future (at least the best future) lies in putting together all of these perspectives without attempting to declare one or another as core and most essential and others as secondary or peripheral. My hope is for a genuinely integrative approach to this range of perspectives, rather than a merely additive one—that is, not just “this is important or useful too,” but a way of taking each facet so seriously that it requires us to rethink all the others. This kind of rethinking does not in any way diminish the importance of the others. It further illuminates their importance.

KF: I might just add here that there exists a two-way street—that as we learn from different kinds of psychotherapy practitioners what they can offer us, they also learn what analysis can offer them, which augers well for the uncertain future of psychoanalysis.

As I consider what we’ve covered, Paul, I can truly appreciate how fortunate you and I have been and what a dynamic time our careers have spanned in psychoanalysis. Psychoanalysis during the past 50 years has come a long way, and it’s been enormously intellectually rewarding to have shared those years and your contributions with you, including this exchange. I think we’ve managed to be quite comprehensive in our allotted space. We’ve captured the origins and evolution of your position, given you an opportunity to elucidate your fundamental beliefs, as well as describe how your views intersect with other contemporary developments. I imagine this reminiscence will provide some stimulating reading for our audience and hope it will honor you and all you have contributed and continue to offer, as you so deserve. As always, it’s been a pleasure to collaborate with you. z

Fantasies, idiosyncratic meaningmaking, ways in which we are not merely responding in some one-to-one way to what is going on are critical to attend to, but for many years, reality retreated too far and fantasy loomed too large.