Women Trailblazers of the Psychoanalytic Tradition

Following the blog article on the rivalry between Kohutian's and Kernbergian's, my partner said,

"What about the women?"

I thought this was a great suggestion for two reasons:

• Many fields including medicine and psychology are seen (and often accurately) as honed for old white men, and while we don't want to overlook this concern in psychodynamics, many women were at the helm.

• Many of my personal influences were women in the field.

Psychoanalysis holds a rich legacy, deeply influenced by the insights of female psychoanalysts. This post celebrates the courageous women who have forged paths in psychoanalytic thought and contributed essential understandings in psychology and psychodynamic theory.

The Early Pioneers

Sigmund Freud referred to his sixth and youngest child, Anna Freud, as his most gifted. She was a pioneer of child developmental psychology, but more notably, Ego Psychology. In her father's old age as the Nazi movement ramped up in 1936 Europe, she presented him a gift - her book coining the term defense mechanisms, cataloging phenomenon her father had described, but not categorized or defined. Sigmund had referred to many defenses, the term repression being both a specific ego maneuver when defined narrowly and an umbrella term synonymous with defense mechanisms when used broadly. However, he had not gathered these terms as a specific category of psychological function. In doing so, Anna created Ego Psychology - in her book The Ego and The Mechanisms of Defense, she applied these psychic phenomenon to her analytic work with children.

While few practitioners I know practice traditional analysis (not because of lack of validity, but practicality), Ego Psychology has maintained steam in the psychodynamic tradition. Defense analysis - the technique of Ego psychology - is absolutely part of my day-to-day practice and interpretations to clients. For example, I frequently encourage clients with anxiety to explore it as a therapist would explore countertransference: what part is yours and what part is elicited by the other party (assuming there is another individual involved as it is nearly ubiquitous that symptoms occur in a social context). The part that is the client's can be explored as introjection - internalizing rules from important developmental figures into the superego - possibly to the degree we might consider it identification with the aggressor (Stockholm syndrome), and projection - the way it is projected on the other person, such as a belief that "if I have an opinion, they will match it with rage to stifle me - good girls/boys don't speak up." When we explore the anxiety as potentially coming from the other person, rather than internalizing responsibility to manage the situation or self-manage/self-control, we alternatively empathize with why that person might behave that way or make us feel that way: why they might be projecting (or that it could be a projective identification). It builds empathy, intuition, agency and free will (opens the door to new ways of responding), healthy differentiation (clear boundary that this might be about the other person and doesn't have to define how I behave, and psychic differentiation - we don't have to comply with introjection), and reduces anxiety.

Karen Horney was another key post-Freudian figure who challenged the gender/sex roles and binary of Freudian thought. We can empathize with the nature of Freud's theory. He was a physician shaping a focus on biology. It was the Victorian era in which there were no prophylactics other than the superego-force of the church to suppress sexual urges from the Id, as it was too costly for most people to have excess children unless putting them to work on the farm (a cultural factor of this epoch). And his own early life experiences, such as a glimpse of his naked mother during a train ride, shaped his theory - namely Oedipal complex.

Horney, on the other hand, put the same emotional phenomenon in the scope of power differentials and dynamics and the consequent oppression. In other words, she was a feminist psychologist. She focused on the helpless frustration of being a small child who must comply with an all-powerful (by comparison) adult (parent), and how this dynamic shapes our early experience and thereby psychology. This child may feel frustrated, angered, oppressed while all at the same time loving, desiring closeness and having no verbal, safe, or effective outlet for feelings of oppression (it likely won't be heard or heeded, and possibly deterred instead).

Margaret Mahler is the final female considered part of the Ego Psychology movement covered here. She worked with (and published on in the 1960's) severely disturbed children considered to be psychotic, but differentiated autism as children who from birth were unable to take or utilize their mother's ego for their own psychology, creating a vast mote between their state and psychological development. The autistic child turns inward to their own comfortable and predictable psychic world, and outward primarily to inanimate objects that are predictable - anything unpredictable is intolerable. Conversely, the psychotic child is stuck in a symbiotic state: self and mother are not distinguishable and challenges of later developmental stages trigger stress due to inability to navigate the differentiation.

Expanding the Realm

Anna Freud pushed the needle from focusing on Id Psychology to Ego Psychology. The next frontier was superego psychology, or Object Relations (OR). The door to this was opened by Melanie Klein. Ironically, this work was being done at the same time as Anna Freud despite the later emergence of OR as a major movement in analysis in Great Britain. This time lapse likely is seated in cultural gender oppression: Klein was a divorced mother studying analysis for decades inspired by her own depression and despite supportive mentors, her ideas were overlooked (in Berlin) until the British OR movement, in which she both influential and arguably misunderstood.

Literature discussing the development of British OR from Kleinian range. One perspective is seeing Klein as the mother of OR and British thought being highly influenced and a direct extension of this thought. Other sources describe the departures from Kleinian thought as simply what one would naturally expect as any like-mind still sees new perspectives. Alternatively, some go so far as so say British OR is a perversion or gross misunderstanding of Klein, positive aspects of her perspective are lost, and maybe some of the approach of OR including deep interpretations would be softened if more of a Kleinian perspective was more purely maintained.

Like Anna Freud, Klein worked with children and developed novel play therapy with the use of toys. Her thoughts conflicted with traditional analysis and ego psychology in certain ways including her focus on expulsive or splitting defense as primary compared to Anna's focus on repression, and mother-child relationship that requires the presence of an ego (or the ability to have relatedness) from birth as opposed to Sigmund's position that the Id is present and Ego develops.

The existence of the Ego allows for relating to the mother and begining to internalize Objects (representations of her) into the superego. These at first are split into seemingly, perceivably incongruent and irreconcilable parts: the good breast that feeds from the bad breast when there is no let-down, good and bad self as it relates to the mother (good self and bad mother or bad self and good mother, respectively). It would not only be inconcievable to integrate these splits self and object parts, but also threatening: to contaminate the bad with the good. Preserving the good mother preserves an idealizable object that provides safety and security. We would associate this fragmented state with psychotic personality organizations that, with a healthy developmental matrix, can gain more structure and integrity.

Out of your Mind

Arguably a shortcoming of OR was that it never escaped the mind. It was focused on a cognitive repository called the superego and thereby relied not directly on objective, tangible outside, interpersonal environment, but on internalized perception of it. It is still an intrapsychic theory. In comes Harry Stack Sullivan (yes, not a woman) who starts exploring his experience as a gay man through early life interactions with "chums" and develops Interpersonal Theory of Psychiatry - a first movement in which we bridge the gap between intrapsychic and interpersonal. This is described as the American counterpart to British OR. Some don't recognize Interpersonal Therapy as its own standalone sub-orientation, but rather consider it as a part of Relational Dynamic Therapy, arguably the most contemporary technology, that reintegrates Interpersonal Theory with prior major contributions including traditional analysis, ego psychology, object relations and self-psychology.

Harvard University was an epicenter for new thought, undoubtedly influenced by the psychedelic subculture featuring thinkers like Timothy Leary. Interpersonal Theory was manualized while prior analytic/dynamic writing was more theoretical than directive. There was arguably an incorporation of cognitive approach to this including more directive interventions and guidance that could be considered more circumscribed which naturally, along with structure, induces limitations. Two examples include Harvard's Interpersonal Circumplex (one writer was Leary) and the Vanderbilt's Cyclical Maladaptive Pattern (CMP) described in Strupp and Binder's book (while less influential today, we should also nod our hat to Luborsky's Core Conflictual Relationship Theme - CCRT).

You should, rightly, be asking yourself why I'm talking about old white guys again? Is our culture so skewed they still find limelight in a blog on women? Fair enough. But I'm laying the groundwork for some of my favorite and most influential contemporary psychodynamic writers.

Lorna Smith Benjamin takes the ball and runs with it in terms of Interpersonal Theory, developing her own version of the circumplex called Structural Analysis of Social Behavior (SASB), which is a tool in her Interpersonal Reconstructive Therapy - a model designed for complex cases (severe personality disorders that have failed other therapies), and writes this book in a manner and with enough guidance for a trainee therapist. This was a majorly influential book given to me by a mentor when working in community mental health. Smith Benjamin was a contributer to the contemporary DSM and offered important insights on Passive Aggression before it was - in my opinion, unfortunately - removed from the manual. Additionally, she includes a chapter specifically about women in caregiver roles in the current gender culture (arguably now shifting somewhat from that time).

Hanna Levenson carried the baton from the Vanderbilt perspective and has continued to write - in the style of Strupp and Binder - down to earth descriptions of Time Limited Dynamic Psychotherapy (TLDP). While I have always been biased toward reading seminal literature first, Levenson and a contemporary, Nancy McWilliams, focused more-so on earlier psychodynamic thought as represented in her book Psychoanalytic Diagnosis including Drive theory, Ego Psychology, OR and "other" models (including "modern") have been important voices in keeping dynamic thought and practice up to date in modern language and literature.

These are not all the names or voices, by any means, but those who stood out in my own intellectual and professional journey, either by direct influence on my approach to therapy or simply as pilars in psychodynamic thought. Certainly the field would be a leg-down without these voices and the knowledge these women pushed forward. Still, 100-years after Anna Freud was learning from her father, female voices are not afforded the same volume or opportunities. What are we missing? When my daughter must have been 18-months to 2-years old, our pediatrician said we were in trouble, implying our intellect was trumped by this little ball of fire we brought into the world. I can't imagine allowing her thoughts to be stifled. Listening to my partner read Magic Tree House, my daughter (now 5) was taken aback and hurt by a book in the series that discussed women's oppression in the Roman empire. It is with sadness we have to open her young eyes to this, but also necessary to know that gender-based power dynamics have and continue to exist.