INTRODUCTION TO SPECIFICITY THEORY, MARCH 7, 2015 For Discussion at 2 - - PDF document

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INTRODUCTION TO SPECIFICITY THEORY, MARCH 7, 2015 For Discussion at 2nd Year ICP PPT Class DISCOVERING THERAPEUTIC POSSIBILITY IN THE SPECIFICITY OF DYADIC PROCESS

by Howard Bacal and Lucyann Carlton (This paper is based on a presentation to The American Psychoanalytic Association, January 20, 2008, modified February, 2015) When Freud first led us from the chaos

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psychological ignorance into the order of psychoanalytic theory, he understood emotional suffering and even certain physical impairments as arising from mental determinants. Over his lifetime Freud developed a nomothetic theory of human development, and of psychological illness, health and

• cure. Freud’s theories were premised upon an ordered and

structured view of mental life, upon which definitive techniques

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psychoanalytic treatment were premised. Freud’s critics - a number of them ultimately hailed as psychoanalytic pioneers – have since elaborated many other

2 theories and different ways of applying them. All these theories differ in their conceptualizations and modes of practice, but each is premised on assumptions of order, continuity, and universality in human development. However, the contemporary ancillary fields of infant research (Sander, 2002; Lyons-Ruth, 2000, 2006; Stern, et.al, 1998) Beebe and Lachmann (2002), neurobiology (Edelman, 1987, 1988, and 1989), physics (Cilliers, 1998), mathematics (Prigogine, 1996), and epistemological philosophy (Gadamer, 1975) turn our attention to an equally compelling aspect

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all biological life

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discontinuous, unique, unpredictable and unorganized in the development and functioning of the human mind (Spruiell, 1993). Contemporary theories in each of these disciplines recognize structure and stable organizations, but give equal weight to their possible instability over time, and to their openness to change in sudden, unpredictable ways. These theories recognize that substantial change may result from seemingly small perturbations, and that stability may be maintained even in the face of massive stressors in the direction of change. While traditional psychoanalytic theories have yielded manifold clinical benefits, it is our thesis that a contemporary psychoanalytic theory that accounts for both

3 the organized, stable, and predictable patterns of mental life, and the unique, the unpredictable, and the nonlinear development and functioning of the mind is needed. This paper introduces a theory that conceptualizes at a higher level of abstraction that encompasses both: stability and structure, and dynamism and process. As we have come to more fully apprehend that all biological life (see Edelman, 1992, 2004; Sander, 2002, Thelan and Smith, 1995; Thelan, 2005; Sacks, 1995; Lyons-Ruth, 2000; Tronick, 2003), Coburn (2014) is formed through an ongoing, unique, dynamic creative process, our psychoanalytic practices must incorporate this quality of development and change. In this regard, we

• ffer

the perspectives

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Specificity Theory, which addresses psychoanalytic treatment at the level of process, while at the same time preserving and recognizing the usefulness of the panoply of possible

• rganizations

posited by traditional psychoanalytic theories. Through explication of Specificity Theory, together with a case example, this paper demonstrates the possibility for the analyst, and the demand upon the analyst, to engage more creatively and effectively with his/her patients. The power of therapeutic action shifts from the careful application of theoretical

4 constructs by the analyst to the powerful idiosyncratic creativity of each analytic dyad. Specificity Theory is a contemporary psychoanalytic process theory that is centrally concerned with the specificity of responsiveness between analyst and analysand that determines psychological healing.1 The essence of Specificity Theory can be stated in a few words: Psychotherapeutic efficacy is a function of the specific capacity for requisite reciprocal responsiveness that emerges within the process of its particular participants. That is, therapeutic possibility will emerge – most often, quite unpredictably - for each particular dyad that will be specific to its capacities and limitations. Thus, therapeutic possibility is both much wider than generally acknowledged, and simultaneously more specific for each patient and analyst. This has significant implication for the nature of therapeutic responsiveness, which we will say more about in a moment. At this point, however, we want to emphasize that this specificity of therapeutic responsiveness is based upon a consideration of psychoanalytic treatment at the level of process¸ This level constitutes a new

• rder
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theory, which

1 The perspectives of Specificity Theory are consistent with many aspects of other process theories, such as

Intersubjective Systems Theory and Nonlinear Dynamic Systems Theory, and complexity theory, as well as with other relationally-oriented intersubjective theories. Specificity Theory has, however, a different focus: the discovery of what may or may not be therapeutically effective for the particular patient, given the therapeutic capacities of the particular participants which emerge at the time.

5 conceptualizes at a higher level of abstraction than psychoanalytic theories that conceptualize at the level of structure. Structure, Process, and the Mind All theories of psychotherapy are premised upon a theory of mind, its development, health, illness and cure.2 While the various schools of psychotherapy offer numerous and contrasting views of mind, a fundamental distinction among theories can be drawn from the definitional essence

• f the nature of the mind either as reified structure or as

dynamic process. When the mind is theorized as structure, it is

• bjectively

knowable and develops and functions in predictable ways primarily according to inherent design. The metaphorical use of the word “structure” (whether as a steam engine, computer,

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multi-story building) to describe the mind invokes similarities to building or fixing an object with a blueprint of the desired product, and with agreed-upon techniques for its successful construction. For example, Freud’s (1923) tripartite structural model of the mind is comprised of an id, ego and super-ego that is formed as the child passes through

2 “Theory of mind is the instrument of psychotherapy” (Friedman, 1988,

151).

6 specified stages of psycho-sexual development (Freud, 1905) and is motivated by the force of two innate drives. Structure theories are the type of theory with which we are most familiar, inter alia, classical psychoanalytic theory, ego-psychology, object relations, and Kleinian theory. This type of theory offers universally applicable concepts for understanding the patient, and prescriptive and proscriptive guidelines for responding therapeutically. In contrast, a theory that privileges process defines the mind as process that is always in process. To further elucidate the meaning and import of mind as process, we detour briefly to the work of a leading neurobiologist, Gerald Edelman (1992, 2004). Specificity Theory’s concept

• f mind as process is corroborated and deepened by

Edelman’s theory of brain development and function. A detailed exposition of Edelman’s work (1987, 1988, 1989, 1992, 1995, 2001, 2004) is beyond the scope of this paper, but his most relevant findings to psychoanalytic theory may be synthesized as follows:

• 1. No two cells in the brain are alike, and no two brains

are connected in the same way.

• 2. There is no single master plan for brain structure or
• function. Brain cells are formed with the potential to

assume a vast number of specific functions. The specific

7 functions, which a particular cell assumes, are determined through the actual experience and functioning

• f the brain within its particular environment over
• time. In other words, the brain is created from the

bottom up by gradual selective processes in interaction with its specific environment. It does not develop according to an external or even genetic master-plan. As the brain is created, it is not only a unique creation, but also one that is specifically fitted to its unique environment. Specificity theory does not attempt to reduce the mind to brain function in either a causal or correlative way (cf, Freud, 1895). Yet it must, along with other theories of mind, be consistent with our knowledge of the brain (Moran, 1991; Davis, 2002). Specificity Theory conceives of the mind as an ongoing, continuous interactive process of

• creation. Specificity Theory explores, expands and applies
• ur awareness of the clinical implications of the mind as

always in process, emergent, and continuously created, and changed through ongoing interaction with its brain, body situate, and its particular environmental surround, human and non-human alike. The view of mind as process versus mind as structure radically alters the epistemology of psychoanalytic theory:

8 the who we come to know, and the how and what we know or can know in our clinical work is altered. With Specificity Theory the analyst comes to know who-he-is-with-his-patient through an ongoing process, which is always subject to change, sometimes dramatically so. In other words, epistemology has significant clinical consequences. Psychoanalytic therapy that is informed by Specificity Theory potentially alters the nature

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therapeutic practice in three fundamental ways: (1) The role that formal psychoanalytic theory assumes in the therapeutic process. (2) The nature of the therapeutic response and the process through which the particular response is derived. (3) The nature of the relationship between the patient and the therapist Structure theories provide the analyst with a type of scaffold

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which the analytic relationship can be

• assembled. Specificity Theory regards structure theories

as assumptions that may expand understanding of the analytic process. Thus, Specificity Theory by no means dispenses with the useful hypotheses, insights, and responses that emanate from structure theories. We recognize that such theory is critical to our work; we cannot think without it. But its role within the

9 application of Specificity Theory is recast as providing possibilities, models to play with and argue against, not as a definitive source of knowledge of any single patient. In addition to formal psychoanalytic theory, with Specificity Theory we also attend to a plethora of other “theories”, both conscious and unconscious, that may influence the therapist’s responsiveness to his patient. Such “theory” derives from the diverse experience of the particular personal and professional life of the analyst – both past and present, and consciously and unconsciously, as well as from his world-view to which these give rise. It inescapably plays a part in determining the responses of the therapist toward her patient. It may be implicitly and/or explicitly operative, and its therapeutic influence can be pivotal and profound. However, its effect can be discovered only if we are aware that it exists.3 The second clinical consequence of the shift from structure to the specificity of process is that the nature

• f the therapeutic response and the process through which

3 The ubiquity of informal, or unformulated, theory, conscious and

unconscious, may be analogous to the “dark matter” of the cosmos that lies between the stars, which we are told may constitute more of space/time than the stars themselves (anywhere from 88-99%). Like the dark matter of space/time, unformulated “theory” does not easily lend itself to identification or description, yet to ignore it may be to disregard much of what also may comprise much of the “space/time” of significant process within psychoanalytic treatment.

10 the particular response is derived is altered4. The

• verarching focus in Specificity Theory is the discovery of

responsiveness that will optimally meet the particular patient’s therapeutic needs, and that is possible for that therapist to offer. The application of Specificity Theory accords therapeutic legitimacy to what had always been tacitly recognized by psychoanalytic practitioners: that what our patients experience as therapeutic encompasses a wide array of responses that includes, but transcends, verbal explanation (that is, interpretation). From the perspective

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Specificity Theory, it is not

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legitimate, but it is essential that the therapist attempt to tailor her responsiveness to each patient. Technique and know-how are supplanted by co-creative discovery of what is therapeutic for that patient, requiring an increased capacity on the part of the therapist to tolerate the anxiety

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not knowing the response that will be therapeutically useful, and whether one can provide it. There are no “guidelines” – no prescribed or predetermined therapeutic responses. Specificity theory holds that all potentially therapeutic interventions in the treatment situation are legitimately utilizable, with the proviso

4 Aristotle (1941) contrasts the distinction between techne and

phronesis as a different relationship between the means and the ends. The technique required to produce an object is defined by the end-

• product. The method required to understand and respond to a person is

itself a part of the creative process.

11 that they not interfere with the therapist's professional functioning or exceed either the therapist's or the patient's personal tolerance. The third clinical consequence that follows from Specificity Theory is that the nature of the relationship between the patient and therapist is altered. A therapist who is guided by a particular structure theory tends to relate from a position of authority over the patient: that he is the one who knows about the patient as informed, at least in part, by his particular structure theory. Specificity theory recognizes that the therapist, who he is, is integral to and inseparable from the therapeutic

• process. When a therapist fully realizes the unique and

creative process of therapy articulated by Specificity Theory, a relationship of a fundamentally different nature

• btains between therapist and patient.

Therapeutic possibility for a particular therapeutic dyad is also significantly affected by the therapist’s commitment both to stretch herself to meet the patient’s therapeutic needs as well as to recognize the limitations that would strain her capacity to respond effectively. This capacity is, at the same time, variously affected by the analyst’s experience of reciprocal responsiveness from the analysand in particular ways. The patient-therapist

12 relationship is much more reciprocal in nature than psychoanalysts have been willing to acknowledge. In effect, the recognition

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the specificity

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reciprocal relatedness and its mutual regulation in any particular dyad can be pivotal to the therapeutic effectiveness of that dyad. In these ways, as you can hear, Specificity Theory significantly expands and, in effect, reformulates the concept

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the transference-countertransference constellation. These three shifts in therapeutic practice engendered by Specificity Theory can simultaneously lead to the enhancing of therapeutic possibility as well as to the crucial recognition of the limitations for therapeutic efficacy of the particular dyad as the specificity of their therapeutic process unfolds. In the case vignette that follows, we illustrate the shift from technique to dynamic dyadic discovery that is embodied within these three clinical consequences. The material also demonstrates how Specificity theory invites a re-examination of several of our well-known concepts and procedures, such as the transference/countertransference constellation, “self-disclosure”, and “empathic attunement”. This example most evidently addresses the response of “provision”.

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