Modern psychoanalysis

Domain I · Psychodynamic & depth psychology · Hyman Spotnitz · 1940

What it is

Modern psychoanalysis adapts Freud's method for preoedipal ("narcissistic") conditions: schizophrenia, severe depression, borderline, character and psychosomatic disorders, and neurotic self-sabotage. Spotnitz developed it from the 1940s with severely regressed patients.

Format

• Format
• Frequency: negotiated. For preoedipal patients, "Once or twice a week is often the optimal number" (Ernsberger, p. 21). Across the school the range runs from one session a year to six a week, and individual work can be combined with group.

Who practises it, and how they are trained or regulated

• How change happens. Symptoms such as withdrawal, depression, fragmentation and somatic complaints are read as a narcissistic defense. Murderous or aggressive impulses toward the object are bottled up and turned against one's own ego or body to protect the object. The analyst first fosters a narcissistic transference, in which the patient experiences the analyst as like himself. Inside that transference the patient…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• It is working when actions are replaced by talk about the impulse.
• It is working when members talk to each other with feeling, not only to the leader.
• It is working when the patient reports feelings, including about you, without self-reproach.
• It is working when the range of topics widens and the patient brings up the off-limits topic on their own.
• It is working when the patient tells you what they need and starts to see themselves as a co-worker in the treatment.

Problems the guide addresses

• Threats to quit, no-shows, unpaid fees (treatment-destructive resistance)
• Stuck, repetitive sessions (status quo resistance)
• Fear of new thoughts and feelings (resistance to progress) and resistance to cooperation
• Overwhelm, fragmentation, psychotic material
• Rage at the analyst, attacks, threats of action
• Ruptures from a premature interpretation or a mistimed join
• Silence and withdrawal
• Patient's first weeks: "nothing is happening," "you're not there"
• Demands for advice, reassurance, gratification or self-disclosure; seduction
• Analyst's own difficulties (countertransference resistance)

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.