1 INTRODUCTION TO SPECIFICITY THEORY, MARCH 7, 2015 For Discussion at 2 nd 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 of 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 of 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 of all biological life - the 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 offer the perspectives of 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 organizations 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 order of 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 of the nature of the mind either as reified structure or as dynamic process. When the mind is theorized as structure, it is objectively 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, or 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 of 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 of 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 our 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:
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