This page has the following content:
The background to an unpublished article that I wrote about Spotnitz and the article itself
A recording of one of the interviews I did with Spotnitz and a summary of another one
A recording of an interview with Larry Epstein about Spotnitz
An unpublished article by Dr. Robert Marshall about Spotnitz
And, coming soon (but not yet here), videos of interviews with Spotnitz conducted by Charles and Deborah Bertshatsky
I couldn’t figure out how to put a link in so that you could jump to any specific section. So if you would like to skip anything, just scroll down.
SPOTNITZ INTERVIEWS and ARTICLE ABOUT SPOTNTIZ
In 1986-1987, I wrote Breaching the Stone Wall, an article about Hyman Spotnitz’s work with schizophrenic patients, and the ways in which it lead to new developments in psychoanalytic technique and philosophy. I was a candidate at the Center for Modern Psychoanalytic Studies at the time, 6 years in, and I was frustrated that his work, which had become so important in my life, was virtually unknown outside of the Modern Analytic institutes. I hoped that a profile article aimed at non-professional readers, in The New Yorker, The New York Review of Books, or the New York Times Magazine might bring this work to the attention of the broader public. Toward that end, I did two interviews with him as well as an interview with Larry Epstein, an analyst at the William Alanson White Institute.
In terms of my goals for the project, my article was a complete failure. It is probably the only article ever rejected by all of the magazines mentioned AND by my home journal Modern Psychoanalysis (the only article of mine they ever declined.)
Nevertheless, many people think it is a good introduction to the history of Modern Psychoanalysis and a basic introduction to Spotnitz’s work. Furthermore, I recently found the recordings of my interviews. So, I decided to post all this material, as well as an article about Spotnitz by Dr. Robert Marshall.
However, the article must be read in the context of the time in which it was written. Psychoanalysis has always been a splintered, sectarian world, and the major factions in1987 were different than they are now. The mainstream was dominated by American classical analysis, but Interpersonal analysis, the American Institute of Psychoanalysis (based on Horney’s work), British Object Relations, and Self Psychology were all very much in the mix. Although CMPS had been founded in 1970 and established Modern Psychoanalysis as an independent orientation, it was completely outside of this mainstream, and there was very little dialogue between Modern Analysts and anyone else in the psychoanalytic world.
In the article, I make a number of points about the philosophical and ethical implications of Spotnitz’s work, as compared to Classical analysis, which Spotnitz himself never articulated as such. However, he did read the final version of the paper and told me that there was nothing in it that he disagreed with or thought was inaccurate.
However, the most influential orientations today — Relationality and Intersubjectivity — were just emerging into the psychoanalytic mainstream with the publication of their inaugural books — Stolorow’s Psychoanalytic Treatment: An Intersubjective Approach (1987), and Mitchell’s Relational Concepts in Psychoanalysis: An integration (1988). I was unaware of either theory at the time. However, both schools make almost the same ethical and philosophical critiques of the classical psychoanalytic stance as I do in this paper, and nothing that I wrote here applies to them.
Here is the article. If you would prefer to just listen to the interviews with Spotnitz and Epstein, or to Dr. Marshall’s article, feel free to scroll ahead to them.
Breaching the Stone Wall: Psychoanalysis and the Challenge of Schizophrenia
...if we are really wise, we will make a working arrangement with the bear that lives with us, because otherwise we shall starve, and perhaps be eaten by the bear...cherish your bear, and your bear will feed your fire.
Robertson Davies, The Manticore
This is the original version that I finished in 1987 and never published. However, updates and corrections in 2022 are noted in this font.
The term schizophrenia, a Greek coinage meaning "split-mind," was introduced in the early years of the century by the Swiss psychiatrist Eugene Bleuler to describe what he saw as a group of mental diseases characterized by "a specific type of alteration of thinking, feeling, and relation to the outside world." At the Burghölzli Hospital near Zurich, Bleuler experimented with many types of therapy for schizophrenia, yet his conclusion was that no complete recovery from this condition was possible. "We do not speak of cure," he wrote, "but of far-reaching improvements."
Bleuler's pessimism about the prognosis of this condition has proved as enduring as the name he gave it; at the present time, almost everybody has given up on curing it. The assumption that schizophrenia is primarily organic has been bolstered by epidemiological studies, yet this has led to no new advances in treatment. Although the antipsychotic drugs that were developed in the 1950s are often helpful in controlling some of the more florid symptoms, they have fallen far short of their original promise. Nevertheless, they are frequently the only form of treatment patients receive. (The medications available in 2022 are far better than what was available in the late 1980’s, and have made a drastic difference in the lives of many [although not all] people with schizophrenia. I do not think it would be ethical today to treat a patient with schizophrenia without offering (but not requiring) a trial of medication.) We are far from the time when people were willing to see madness as a sane response to an insane world. Except for Thomas Szasz, who argues that schizophrenia only exists in the eyes of psychiatrists, and a few family therapists who believe that it can be cleared up in a few sessions, the prevailing view is that schizophrenia is a basically hopeless condition; the best that can be done is to help schizophrenic patients learn to live with their condition as comfortably and quietly as possible - a goal usually described as rehabilitation.
One of the few people who is optimistic about schizophrenia these days is Dr. Hyman Spotnitz, a psychoanalyst who has been studying schizophrenia for over forty years. Spotnitz has developed a form of psychoanalysis that he is convinced can cure schizophrenia, in the sense of eradicating both the symptoms and the cause of the problem. Spotnitz has come to view schizophrenia less as an exotic mental illness than as a self-destructive attempt to solve one of the most basic of human problems - the management of aggressive feelings - and the therapy that has evolved from his work makes use of these feelings in a way that has challenged analysts to adopt a very different type of relationship to their patients, and to themselves as well.
Psychoanalysis is a sectarian world, where even minor deviations from the party line have led to a welter of splinter groups, so it is hardly surprising that his work has not been accepted by the psychoanalytic establishment. But the issues raised by Spotnitz's work go beyond parochial debates about psychoanalytic technique to a reconsideration of some of our basic attitudes towards human emotion: What sorts of feelings must be included within the range of "normal experience?" Which kinds of emotional interactions are curative? And most importantly, how can we learn to handle our own frustration and aggression without making ourselves crazy or harming anyone else? Spotnitz's work on schizophrenia provides a unique perspective on the broader question of how to deal with the most destructive of human impulses.
Freud always maintained that psychoanalysis was not an effective form of treatment for the psychoses, the group of mental disorders which included what is now known as schizophrenia. He found that his major therapeutic tool - the interpretation of symptoms - made no impact on psychotic patients. His explanation was that interpretations were only curative when the patient was able to form a "transference" to the analyst - an emotional relationship that recreated the patient's earliest relationship with his parents. Transference is a normal phenomenon that occurs to some extent in all interpersonal relationships, and most patients spontaneously developed transference to the analyst. The problem in psychosis was that such patients were surrounded by a "narcissistic wall" which left them incapable of forming relationships - including transference relationships - with anyone. Consequently, they rejected the analyst "not with hostility, but with indifference" - a situation that made analysis impossible.
Freud's views on future prospects for a psychoanalytic treatment of schizophrenia were ambiguous. He continued to refer such patients to analysts who were willing to work with them, sometimes with the comment that they were "analytically unfit for anyone." Although he suggested that effective techniques might someday be developed, he was harshly critical of those of his followers who attempted to modify the practice of psychoanalysis in any way. Most of the early analysts viewed his ideas about most everything as final, and his notion that schizophrenic patients were incapable of forming relationships was no exception.
That anyone actually believed this was remarkable, for it was obvious to those who worked with schizophrenic patients that they could form very strong emotional relationships, provided the analyst was interested in them and created the right environment. This was recognized by Harry Stack Sullivan, a psychiatrist who directed the first efforts to apply psychoanalytically-oriented treatment to schizophrenic patients in the United States. Sullivan, who was himself schizophrenic intermittently throughout his life, went so far as to make interpersonal relationships the cornerstone of his therapy with schizophrenics. He suggested that unsatisfactory relationships during the period of pre-adolescence could lead quite directly to schizophrenic breakdown. At Sheppard Pratt, a private psychiatric hospital in Maryland, Sullivan set up a hospital ward designed to provide a sort of ideal pre-adolescent social environment that would provide the patients with experiences that they should have obtained when they were younger. Some of his methods were quite eccentric. For example, his model psychiatric ward contained only men, staff and patients alike. Nevertheless, his work was very successful. Sullivan gave people the idea that schizophrenia was a "human process" - a condition that could be understood and healed.
The most dramatic treatment of a schizophrenic patient was made during the 1930's by Marguerite Sechehaye, a Swiss analyst. She began working with Renee, a deeply disturbed 18-year-old woman, with classical analysis. She soon found that she was having only a minimal impact, as Renee was increasingly gripped by delusions of being imprisoned in a persecutory organization she called "the System." Based on the nature of Renee's delusions, as well as on her personal history, Sechehaye viewed many of Renee's problems as being related to the severe frustration that she experienced with her mother as an infant. With these life experiences in mind, she dispensed with interpretations and experimented with meeting Renee's frustrated infantile needs in a symbolic way.
At one point, for example, Renee had stopped eating, and the only food in which she expressed any interest at all was green apples. But even these she would not touch. After a few experiments, Sechehaye tried putting the apples to her breast and then inviting Renee to sit on her lap to eat them, as if they were nursing. Renee began to eat again - and she began to recover. Sechehaye continued to try to provide her with experiences that symbolized the types of things that a baby needs in order to grow and mature. After eight years of work, the results were remarkable: Renee was not only cured of her schizophrenia, but she also went on to have a successful academic career and a satisfying life.
In addition to the "symbolic realization" of Renee's needs, Sechehaye also provided her with something that was equally important to her recovery: genuine feelings from the analyst. The feeling that seems to have been most important to Renee was the powerful and caring love that Sechehaye gave to her. The effects of this love were not always consistent: Renee suffered some harrowing periods of deterioration following some of Sechehaye's loving gestures. Nevertheless, her account makes clear that it was her emotional communication that made her work with Renee so effective. While Freud discovered that it was essential for the patient to have an emotional relationship with the analyst, Sechehaye showed that it was equally necessary that the analyst have an emotional relationship with the patient.
As a young medical student in the early 1930s, Hyman Spotnitz had heard that schizophrenia and cancer were the two biggest challenges facing medical science; he decided that he wanted to tackle schizophrenia first. He prepared for this by studying the psycho-physiology of vision at the Kaiser Wilhelm Institute of Brain Research at Berlin-Buch and then the structure of the brain at the Neurological Institute in New York. He first began working with schizophrenic patients as a resident at the Psychiatric Institute in New York City, where he was exposed to the whole range of therapies in use at the time. He was impressed by insulin shock treatment, and even more so by an ambulatory insulin treatment that kept patients free of psychotic symptoms provided that it was administered on a daily basis. However, the symptoms returned as soon as the insulin was discontinued. He found that only psychotherapy seemed to provide permanent change.
In 1940, he entered the New York Psychoanalytic Institute in order to see what psychoanalysis had to offer in the treatment of schizophrenia. Freud's work was the letter of the law at the Institute, on schizophrenia and everything else. Nevertheless, Spotnitz's supervisors at the Institute did not object to his work with schizophrenic patients, and his analyst, herself analyzed by Freud, actively encouraged his interest. He says that she gave him "the opportunity to go psychotic myself and talk out my own insanity in analysis," an experience that was crucial in learning to deal with schizophrenic patients. Eventually, however, his interests got him in trouble with the Institute's Educational Committee, who insisted that his patient - who was schizophrenic - was not an appropriate psychoanalytic case. They refused to pass him on his clinical work and Spotnitz, unwilling to choose a different patient in order to comply with a theory he didn't accept, finally left the Institute without graduating.
Not all psychoanalysts in the late 1940s accepted the orthodox views on schizophrenia. Many of those who did work with schizophrenic patients, particularly those who were influenced by Sullivan, held that the condition was largely a reaction to having been chronically exposed to rejection and hostility as children. As a result, they became hypersensitive to aggression from others. They avoided emotional involvement with other people as a "security operation" - an attempt to avoid the anxiety that might result from further experiences of this kind.
Spotnitz agreed that many patients had been exposed to such experiences, but he also saw that they were consumed by their own feelings of frustration and murderous aggression. These feelings might be reactions to actual frustrations or rejections, or they might result from a temperamental mismatch between the patient as a child and his family. The feelings were not in themselves problematic, as all people experience such feelings in the course of their development, and in normal development, a child learns safe modes of expression for these impulses. What was different in the development of schizophrenia was that the child had somehow acquired the sense that his parents could not survive his rage - that his feelings could actually destroy other people. They were not simply feelings, they were extraordinarily dangerous weapons.
Yet no matter how angry and frustrated the child felt, he still loved and needed his parents, and he did not want to destroy them. So he became dominated by a concern to protect them from his dangerous rage. But with no safe mode of discharge, the rage accumulated in the mind, intensifying to seemingly volcanic proportions. Finally, in an attempt to blot out all awareness of these feelings, the aggression was discharged against the child's own ego. Spotnitz later described the process as being akin to "smashing a gun to bits to prevent oneself from pulling the trigger." The consequences were devastating: thinking became fragmented and chaotic, and hallucinations and delusions developed.
Spotnitz called this state, in which feelings that should be discharged outward were all directed towards the patient himself, "the narcissistic defense." Furthermore, in his constant effort to protect other people from his aggression, the patient became adept at avoiding emotional contact with others, whether by making themselves unbearable to be with or by simply ignoring the world around them. Nevertheless, the pattern of experiencing intense aggression and needing to obliterate these feelings was compulsively repeated whenever the patient did become close to another person, including the analyst. This created the misleading impression that the patient was antisocial, as he appeared indifferent to those around him. Actually, Spotnitz wrote, he was "a very social-minded human being. Too social-minded, in fact, for his own good." This was the transference that Freud had not recognized; the indifference that he had noticed served to shield the analyst from their hostility. Schizophrenia was a defense against committing murder.
Other analysts, such as Melanie Klein and her followers, had made similar observations about the central role of aggression in schizophrenia. What was most original about Spotnitz's work was the approach he used to treat the condition. He found that this schizophrenic reaction could be reversed when he was able to reactivate the patient's murderous feelings with him in such a way that the patient learned that the analyst could withstand their full intensity - provided their expression was limited to language. Words were a mode of discharge that schizophrenic patients had been deprived of as children. Putting the full measure of their rage into words showed the patient that feelings were not lethal. As the patient talked, he became able to experience his aggression without killing the analyst or becoming psychotic.
Words, of course, were the major tool of psychoanalysis since its inception. Anna O., the first psychoanalytic patient, had called it "the talking cure." But due to the schizophrenic patient's idea that feelings themselves were dangerous, he was reluctant even to talk about them. One patient described the process of experiencing her aggression as "being dissected while you're still alive." Interpretations tended to frighten patients by making them consciously aware of their objectionable feelings before they were able to control themselves. A different approach was needed.
Spotnitz found the solution in the emotional relationship that developed between the patient and the analyst in the course of the analysis. More systematically than Sechehaye, Spotnitz studied his feelings about the patient, being careful to distinguish his own idiosyncratic responses from those feelings which seemed to be realistically induced by the patient. Some of these induced feelings were positive, such as wishes to love or nurture the patient. Other feelings were extremely negative: the analyst hated the patient as the patient hated himself, or the analyst began to hate himself. He sometimes felt terror in the face of the patient's aggressive impulses or had equally intense murderous impulses towards the patient.
Spotnitz also experimented with making use of these feelings in the analysis. For the first two years, he tried using a very loving approach; he was shocked to find that his patients sometimes stagnated, and even deteriorated, in such a positive atmosphere. His explanation was that their tendency to turn their aggression against themselves was intensified when they found themselves hating a loving person. In order to help them turn their self-hate into aggression against him, he made use of the negative feelings that had been aroused in him to appear dictatorial and mean. Only then did the patients view him as a worthy object of their hostility, and only then could they be sure he would survive it.
It was often these aggressive feelings from the analyst that played a major role in bringing the patient out of the psychotic state. In part, discharging his hate against the analyst relieved him of the "constipated rage" that disordered his mind. However, this catharsis was just temporary. Even more important was that by expressing such feelings himself, Spotnitz communicated that people could have such feelings for each other without anyone being destroyed. The patient was not unique - and when the analyst was able to accept himself as a hateful person, the patient was able to do this, too.
Spotnitz especially emphasized aggressive feelings because he saw this problem at the core of schizophrenia, but this was not the whole process. Rather, he worked to create an environment in which a patient could learn to feel comfortable with the whole range of human feelings - no matter how painful they were to the individual or how unacceptable they might be to society. The rage and frustration that had led the patient into psychosis did not go away; nothing could eliminate these feelings from the patient's experience. But new feelings arose as patients became able to talk about the emotions that they had been fighting so hard to destroy.
The aggressive discharge was necessary in order to free the patient to love. Positive experiences became possible after the patient realized that he could hate the analyst without damaging him. Following an exchange in which Spotnitz and a patient both shouted that they wanted to bash each other's heads in, the patient exclaimed, "You really do hate me as much as I hate you, and you can be even more vicious!" At a later point in the treatment, he solemnly told Spotnitz, "If you can take what I've dished out here and give it back to me, you're my friend for life."
Although these emotional interactions seemed sometimes wild and spontaneous, Spotnitz found that it was essential that they be carefully planned; an emotional communication that was therapeutic at one point in the analysis might be damaging earlier on. The feelings also had to be directly related to the patient's emotional needs, uncontaminated by feelings related to the analyst's own personal problems. And, in order to be effective, the feelings had to be genuine.
This use of the analyst's feelings as a therapeutic tool violated the cardinal tenets of classical analysis. Early in his work, Freud briefly considered using feelings in this way, but later rejected the idea. In the technique he developed, insight was seen as the factor that cured the patient: the patient's feelings about the analyst were the raw material to be analyzed, and the analyst's interpretations catalyzed the acquisition of insight. Freud came to view all of the analyst's emotional responses to the patient - countertransference - as a serious obstacle to treatment. He said that the analyst should work like a surgeon, without regard for his feelings about the patient. Many analysts interpreted this to mean that they should not have any feelings at all about the patient.
In the view Spotnitz developed, however, the analytic relationship is itself curative; insight is the secondary byproduct of emotional growth, not its effective cause. What the analyst must provide the patient is not an explanation of his symptoms but rather the emotional communications that will enable him to experience and verbalize all of his feelings.
Other analysts besides Spotnitz who worked with schizophrenic patients in the late 1940s and early 1950s had experimented with using emotional communication. And a few others shared his interest in the use of aggressive feelings. Harold Searles was exploring much the same emotional terrain in his work with severely schizophrenic patients at the Chestnut Lodge Sanitarium in Maryland. And in England, Donald Winnicott had written a pivotal paper in which he discussed the role of hate in normal development and the "truly objective hate" that the psychotic patient often arouses in the analyst. Winnicott said, "If the patient seeks objective or justified hate he must be able to reach it, else he cannot feel he can reach objective love."
But these were minority views. Most of the influential theorists, such as Frieda Fromm-Reichmann, Kurt Eissler, and Silvano Arieti, insisted that the schizophrenic patient had to be carefully protected from all negative feelings - especially from those of the analyst. Nor was the patient encouraged to express his own aggression, as this was viewed as exacerbating the problem. The patient was seen as a fragile victim who could only be nursed back to health with lots of tender loving care. For the most part, accounts of the therapeutic effects of aggressive feelings were treated as curiosities or dismissed as "wild analysis" - treatment that was considered impulsive and unscientific.
The differences between this approach and Spotnitz's were as much philosophical as technical: Spotnitz believed that all feelings were both acceptable and necessary and that even the most potentially destructive feelings could serve a valuable role in a "well-orchestrated personality" - as long as a person could learn to experience them without acting on them. In contrast, the theories which focused exclusively on love reflect a view of human emotion and interpersonal relations in which feelings of murderous aggression have no place. There is no sense in these theories that two people could hate each other and still maintain a relationship. Such feelings are deemed dangerous and unacceptable; they could be managed only by eliminating them or denying their pervasiveness. Of course, the existence of these feelings could not be ignored - at least not in the patient. But they were seen as a symptom of his illness, not as an integral part of human experience. It was argued that the analyst was not supposed to experience feelings similar to the patient's hostility; he was supposed to be more mature than that.
From the perspective of Spotnitz's work on schizophrenia, these views rejected the emotional reality of the analytic relationship. These feelings were an inevitable part of what the patient needed to communicate to the analyst. To avoid such feelings was to avoid a genuine interpersonal relationship with the patient in a way that robbed the situation of its therapeutic possibilities. The analyst's refusal to acknowledge his own hate reinforced the patient's idea that there was something very wrong with these feelings. And, if the analyst's feelings were of a qualitatively different sort than those of the patient, then the ground of common experience that enabled the patient to venture beyond the walls of his isolation was gone. The patient and the analyst were no longer of the same stuff.
The notion that the patient and the analyst were fundamentally different received support from the increasing interest in the psychology of the ego - the agency of the mind which mediates between the internal and external worlds. A healthy ego was said to be able to "neutralize" primitive aggressive and sexual components of the mind. Schizophrenic patients were said to have damaged egos, a fact that explained their intense aggression. Analysts, on the other hand, who were supposed to have healthy egos, were not supposed to have these feelings. And if they did, it was a serious problem to be kept out of the analysis.
No matter the justification, the therapeutic approaches which were limited to positive feelings failed to provide consistent results. Perhaps out of frustration with this situation, interest in using emotional communication in analysis diminished in favor of theories that emphasized the purely rational aspects of psychoanalytic treatment. The orthodoxy hardened in its insistence that interpretation was the only genuine psychoanalytic technique; other techniques were permitted only if they were eventually replaced by interpretation. The study of psychopathology, which Freud had used to explain, to expand, and ultimately to relativize the concept of normalcy, was now put to the opposite use of reinforcing the differences between the two states. A patient's ability to respond to a rational psychoanalytic interpretation became the acid test of normalcy: those who failed this test were said to have a deformed ego and were deemed to be unanalyzable. Thus, the limitations of psychoanalytic technique were redefined as limitations in the patient. Psychoanalysis became a therapy for the healthy elite.
Other types of psychotherapy were devised for patients who were officially classified as unanalyzable, a group that included not only schizophrenics but an ever-growing group of people who did not respond to classical technique. A number of the published accounts of this work were sensitive and exciting. Unfortunately, one senses that the patient's progress was often limited by the analyst's assumption that the situation was beyond repair. Furthermore, it was classical psychoanalysis, undiluted by these modifications in technique, which maintained the aura of the most prestigious of the psychotherapies.
This hierarchical perspective was strongly contested, in the early 1960s, by the "anti-psychiatry" movement, a group of psychiatrists, psychoanalysts, and philosophers who, like Spotnitz, were interested in new approaches to schizophrenia. Some aspects of the work of R.D. Laing, the British analyst who became the most influential of the anti-psychiatrists, are similar to Spotnitz's views. Laing also saw the need for the patient to express hatred in the analysis, and both of them viewed schizophrenia less as an inherent deficiency than as a necessary adaptation to an environment that had failed to meet the patient's needs. Laing, however, tended to describe schizophrenics as people who were undergoing a journey of cosmic rebirth and who were oppressed by society for their non-conformist experience of reality. For Spotnitz, on the other hand, the only positive value of schizophrenia was that it usually enabled the patient to survive without killing anyone; beyond that, it was a lonely condition that contained no further potentialities for growth, and he devoted his efforts not to celebrating it but to curing it.
The late 1950s and early 1960s were also the period in which family therapists were developing a whole range of new techniques to treat schizophrenia and other types of disorders. Spotnitz was a close friend of Nathan Ackerman, one of the founders of the family therapy movement and he was influenced by him as well as by other family theorists. Spotnitz shared their interest in the role of the family in the etiology and treatment of schizophrenia, and he often worked with family members, either individually or altogether. Many of his techniques made use of seemingly irrational communications in ways that resembled the paradoxical therapy that grew more out of the work of family theorists such as Gregory Bateson, Jay Haley, and Don Jackson, than out of anything that was being done in the field of psychoanalysis. Despite their similarities, however, the goal of Spotnitz's work was different from that of the family therapists. Where the family therapists tried to create rapid change in the family's functioning, Spotnitz never worked to directly change behavior; his conviction was that the most durable form of change, and the type of change that created the greatest degree of personal autonomy, was the result of people becoming able to talk freely about their feelings, and all of his techniques were designed only to help people to do so.
Spotnitz's work on schizophrenia has evolved into a form of analysis that is limited neither to psychotic patients nor to the very few people who are considered to be appropriate for classical analysis. Throughout the 1950s, Spotnitz worked at the Jewish Board of Guardians, a family service agency in the Bronx, where his approach proved effective with patients from a broad range of economic backgrounds. Since then, his techniques have been used in settings as varied as state mental hospitals, exclusive private practices, school counseling centers, and even an outreach program for homeless people. Because it is focused on the emotional communication between patient and analyst rather than on the "capacity for insight," factors such as low intelligence or poor education are not considered relevant to the success of the treatment. What is most important is the patient's desire to recover, the analyst's ability to provide the proper emotional environment, and their mutual determination to keep the patient talking. Under these circumstances, says Spotnitz, the patient "has no choice but to improve."
Spotnitz's work on topics such as countertransference, aggression, and narcissism has predated, in a more far-reaching form, most of the theories that are currently popular. However, his work has remained outside the mainstream of contemporary psychoanalysis, and it is almost never mentioned by other theorists. Modern Analysts (as Spotnitz's followers are called) often feel that his work has been deliberately ignored. In fact, few classical analysts have even heard of Spotnitz; at the same time, it is true that he has usually been dismissed by those that have. According to Dr. Lawrence Epstein, one of the few analysts who has been profoundly influenced by Spotnitz while remaining professionally affiliated with the traditional psychoanalytic establishment, Spotnitz and the Modern Analysts "have been accused of being crazy, sadistic, and manipulative - all kinds of terrible things."
Some Modern Analysts have, at times, exacerbated this impression by presenting aspects of their clinical work - techniques that are striking, yet easily comprehensible within the conceptual framework of Spotnitz's theory - in ways that are so out of context that they sound quite bizarre. While those who are aware of the rationale for these techniques are highly appreciative of such dramatic demonstrations, this practice has often repelled people. In addition, many less experienced Modern Analysts ignore the psychoanalytic tradition and present Spotnitz's work as if he simply picked up where Freud left off, a habit that has alienated them from other schools of thought. Epstein feels that Spotnitz and many of the people he has trained seem to have "followed a mode of presentation which is designed to get them the greatest possible rejection."
Nevertheless, the content of Spotnitz's work poses problems for analysts which are far more substantial than his style of presentation. In effect, he has dethroned the analyst from the traditional position as the arbiter of the truth of the patient's emotional experience. "A classical analyst," says Epstein, "in order to feel like a proper analyst, is supposed to decipher the unconscious meaning of the patient's communications and communicate this meaning back to the patient. Modern Analysts don't do this. Rather, the Modern Analyst often functions as a simple, naive investigator - a posture that deprives the analyst of the experience of impressing the patient with his brilliance. This is disagreeable to the self-image of many conventionally-trained analysts."
Dr. Murray Sherman, a contributor to the development of Modern Analytic theory, has argued that Modern Analysis is conducted as a method of investigation, rather than as a method of explanation. In practice, this means that the analyst usually does not use interpretations to correct a patient's apparent distortions of reality but instead accepts them and explores their meaning with the patient. Epstein says that traditional analysts have viewed this as being manipulative because they presume that the analyst knows the truth about these distortions; to go along with them without communicating this truth to the patient is deemed to be ingenuine and to transform the analysis into a process of "lie therapy."
Of course, classical analysis, conceived in this way, is based on truth only if one accepts the assumption that the analyst really knows the truth about reality with greater certainty than the patient. (The idea that the analyst does not have superior or authoritative knowledge of either reality or the meaning of the patient's experience is also a core aspect of contemporary Relational and Intersubjective thought. These ideas were developed independently.) Yet this emphasis on the importance of communicating the truth to patients also highlights a profound distrust of any type of therapeutic interaction which is based on feelings rather than insight and understanding. For the most part, this seems to grow out of an a priori assumption that insight is the superior form of change - a rationalistic distrust of feelings in general.
Today, all but the most rigid Freudians believe that a certain amount of positive feeling for the patient is necessary to create a "working alliance." And over the last fifteen years, there has been widespread interest in the analyst's feelings as a source of information about the patient. However, these feelings are supposed to be used only to understand the patient. The idea of using feelings as a primary therapeutic tool remains anathema not only in classical psychoanalysis but in most other types of insight-oriented psychotherapy as well. (This is no longer as true in 2022 as it was in 1987, and many insight-oriented therapists, including classical analysts, make much more liberal use of feelings than they did at the time. However, I believe that Modern Analysis remains distinct in the range of feelings that are used therapeutically. My book, Emotional Communication: Countertransference Analysis and the Use of Feeling in Psychoanalytic Technique, provides a comprehensive overview of the range of emotional communications used in Modern Psychoanalysis.)
Other schools of psychotherapy, for the most part outside of psychoanalysis, have argued that a therapist has to be a real person with the patient and have made the use of feelings an important part of their work. Carl Rogers, for example, has long insisted on the need for therapists to provide patients with unconditional acceptance and warm empathic support. Within psychoanalysis, Heinz Kohut's "Self Psychology" has maintained that the analyst's empathic responses to the patient are the crucial curative experience in analysis.
But like the analysts of the 1950s who advocated an exclusively loving relationship with schizophrenic patients, all of the contemporary therapists who do use emotional communication in psychotherapy have limited it to a narrow range of positive feelings. The only notable exception is Searles, who has also embraced the full range of feelings in his work and who has also been subject to much the same type of criticism. Spotnitz himself thinks that the major reason that his work has been ignored is that analysts do not want to have the sorts of feelings towards their patients that his approach requires. He says, "The psychotic patient makes you feel like killing him. The schizophrenic patient says 'kill me before I kill you.' That's his attitude, and the classical analysts don't want to deal with this countertransference." And it is not just murderous feelings that this work entails; Modern Analysts insist that analysts must be able to experience, and on occasion to express, any feeling at all that a patient requires, including states of sexual and romantic excitement, suicidal hopelessness, and psychotic confusion.
This idea not only conflicts with the traditional ideal of an analyst who can function without having any feelings about the patient but also threatens the way that analysts view themselves. His work asks them to acknowledge that they have the same types of emotional experiences as even their most disturbed schizophrenic patients - a step many analysts seem unwilling to take. Indeed, the current vogue for ever more sophisticated diagnostic distinctions between types of patients has seemed to have made analysts less likely to acknowledge their own "pathology" than ever before.
Another complaint that has been made about Spotnitz and the Modern Analysts is that they are focused on hate and aggression to the exclusion of love. Although this is a distortion of Spotnitz's work, it is to some extent understandable. Until the late 1980s, the major emphasis in his writings had been on the importance of working with aggression. This has, at times, been misinterpreted by some of his followers to mean that helping a patient to become enraged at the analyst is all that is necessary to cure. Actually, the ability to love has always been the goal of Spotnitz's therapy, and loving feelings have always been an indispensable aspect of his work. For example, Dr. Phyllis Meadow, the most influential Modern Analyst after Spotnitz, has described a case in which her strong wish to run off with a patient and live with him forever was the basis of an emotional communication that marked a turning point in his treatment. In recent years, Spotnitz and many of his colleagues have emphasized the importance of love and caring more explicitly than in the past.
Still, some critics have claimed that Spotnitz has introduced the use of aggression in analysis as an outlet for his own hateful feelings. But this type of criticism seems based again on an unwillingness to recognize the universality of aggressive feelings. For, as Sullivan put the matter, "We are all more simply human than otherwise." There is no question that there is aggression at every level of human culture, from the individual to the international. The issue is whether we can manage aggressive feelings most constructively by viewing them as an abnormality - a symptom of somebody else's disease - or by accepting them, and all feelings, as part of the common human experience and using this common experience to enrich our own lives and those of others.
The interviews with Spotnitz and my personal experience of interviewing him
The article was based on two interviews that I did with Spotnitz, and one with Larry Epstein. Spotnitz was 78 at the time. I was 31.
Unfortunately, I only recorded the second interview that I did with Spotnitz (bad planning on my part), which was actually the more interesting of the two.
These two interviews were virtually my only contact with Spotnitz, nor did I do extensive research on his life beyond these interviews. Thus, I don’t consider myself to be his biographer. Unlike almost all of my mentors, supervisors, and colleagues, I was never in ongoing group or individual work with him either in analysis or supervision.
Getting an appointment with Spotnitz was an ordeal, as I will describe below. But once in the office with him, he was completely straightforward and transparent. I did have a personal consultation with him the following year to discuss a conflict with one of my analysts. I was trapped in the quandary of thinking that the analysis was hurting me, but I feared that I would be acting-out self destructively if I left. What if this was something I needed to work through!? Spotnitz was again completely straightforward. He told me to trust myself if I wanted to leave. He said my analyst was a competent man, but that wasn’t reason enough to stay. Wasn’t I old enough to leave home if it was time? I wish I had been strong enough (old enough?) to follow his clear advice at that time. But what struck me was that this brilliant analyst, known to say amazing, surprising, dystonic, paradoxical, complex, outrageous, or unexpected things, spoke to me with utter simplicity and with full respect for my adult autonomy and judgment.
Highlights from the first interview:
Many of the points Spotnitz made in the first interview were repeated in the second interview. But alas, not everything. Because I did not tape the first interview, I’m providing a summary, from distant memory, of the highlights of the first interview.
I started by asking how he became interested in treating schizophrenia. He said that at the time he was in medical school, schizophrenia and cancer were considered the greatest challenges in medicine. “I figured that I would do schizophrenia first, and then I would do cancer,” he said, laughing. Later in the interview, he said that he lost his wife to cancer, and he wished he had started with cancer so that he would have been able to cure her. No laughter this time.
He worked at the Kaiser Wilhelm Institute in Berlin during the early years of his medical training, and he was very interested in the work he was doing there, some of which was on how the eye worked. He also saw electroshock and insulin shock therapy with schizophrenia. He was particularly impressed with insulin shock. However, the results were always temporary.
(It didn’t strike me till afterward that he was in Berlin during the rise of Nazism. I wish I had asked him what it was like to be a Jew working in Berlin in the 30’s. But I didn’t, and I’m still surprised that it didn’t come up.)
He went to the New York Psychoanalytic Institute to see what they had to teach about schizophrenia. He said that they didn’t have much to teach him and that they discouraged his interest. When they rejected his choice of a schizophrenic patient as his control case, he decided to leave the institute. (He told me who he trained with, and we went over this again in the second interview. For more on his time at New York Psychoanalytic, see Robert Marshall’s wonderful paper, The Influence of Hungarian Analysts on Hyman Spotnitz and the Modern Psychoanalytic School. Modern Psychoanalysis (2015) 40:1-35
I asked him about Kurt Eissler’s idea that the only truly psychoanalytic technique was interpretation, and that the test of whether someone had a healthy ego was whether they could make use of an interpretation. (This idea, largely forgotten now by all but the most orthodox classical analysts, was still extremely influential at the time.) But that other patients, who did not have healthy egos, could be treated with “parameters of technique” — interventions that were not interpretations. Spotnitz said, “I viewed that paper as an attack on my work”
I had written to him before contacting him to tell him what about the article I wanted to write and ask if I could interview him. I called him several days later and he told me that I could, that his new fee was $200 per session, and that I could call him when I was ready to make an appointment. I expected, from hearing many stories, that in order to make the appointment I would have to call several times: he would then give me other times to call him back, and that this rigamarole could go on several times. It was said that this was his way of testing someone’s motivation. So I wasn’t surprised that when I called him he almost immediately told me to call back at another time, something like Tuesday at 2:17. It was extremely inconvenient, but I knew it was the only way in, so I arranged my day to make it work. Nevertheless, I was shocked when I called back at the exact time (I had to use a payphone in the rain—remember those?) and he barked, “This is the wrong time! Call back on Monday at 10:15”. I dutifully called at that time, and he immediately gave me an appointment. He greeted me warmly when I arrived and told me that he was favorably impressed with my work. Later in the interview, I asked him why he had put me through that when it was obvious that I was going to come. He said, “Oh, that second time you called was just when a group was ending and I was feeling harried and irritable. It had nothing to do with you,”
I asked him why he was often combative with analysts of other orientations at conferences. (I had never seen this but heard of it many times.) He said, “If I didn’t do that, everyone would want me to cure them, and I would get exhausted. I have to do that to keep people from wanting to work with me.” (At the moment, I thought this was absolute bullshit. ‘Dr. Spotnitz, the master of working with aggression, can’t say no?’ But, years later, when he was near the end of his life, I learned about one last group who couldn’t or wouldn’t terminate with him. Apparently, he was often incoherent but would still say something brilliant in almost every session. I remembered his comment to me, and I understood that he had been completely honest with me: he really couldn’t say no in an ordinary way if people wanted to work with him, and he resorted to these “techniques” to screen out as many people as possible)
I asked him about treating borderlines, and whether it was different working with schizophrenics (almost every major analyst except Spotnitz wrote a book about treating borderlines in the 1980s, and I was curious why he hadn’t; he said that it was all about teaching them to control their behavior in public. It was like teaching them to use the bathroom. He didn’t seem to be working to cure them of spitting or create object constancy or any such thing. It was soley about helping them to learn to discharge their rage privately. I didn’t ask him to elaborate.
I asked why Modern Analysts began all patients’ analyses as if they were schizophrenic. He responded emphatically; “Those people on 10th Street (CMPS) do that, but that is not my teaching.”
I said that I had heard that he used the couch with people he supervised. He chuckled and said that those people were confused about what they were doing with him, but that was OK.
At some point, the question of how long an analysis should last came up. (I don’t remember the context.) I commented that he had worked with many people for thirty years or more. He said that was true, but that he had also worked with many more people for one year, a few years, or five years and considered that work to be valuable too. He clearly did not think that you were supposed to stay in analysis forever if you didn’t want to. He went on: “At this point in my life, if someone says they want to leave, I just say “Gei gazinta hait”! (Yiddish for “go in good health)”, chuckling, with a large dash of irony.
Those were the main points of the first interview.
The second interview can be heard at this link. Unfortunately, the sound quality is terrible. It was a hot summer day, and the window air conditioner was very loud. I tried to have the sound corrected, but it didn’t work. It is much easier to understand if you listen through headphones of some sort.
Interview with Dr. Larry (aka Lawrence) Epstein.
I tried to arrange interviews with other major psychoanalysts to get their views on Spotnitz’s work. Otto Kernberg never responded. (I’m not surprised. I have no idea if he ever heard of Spotnitz, and I was a complete nobody.) Kurt Eissler, on the other hand, responded with a nice note apologizing that he didn’t know anything about Spotnitz or the treatment of schizophrenia and couldn’t contribute anything. And Harold Searles, the brilliant analyst most similar to Spotnitz in his interests and technique, left me a forlorn-sounding voicemail; “Mr. Geltner, I appreciate your interest in my work, but I just can’t.”
Larry Epstein, however, had (with Arthur Feiner) edited a book of contemporary (at the time) papers on countertransference that included one by Spotnitz. I think so, but I don’t have the book to double-check.). And, I had heard that he had some contact with Spotnitz. He graciously agreed to meet with me. He worked largely as a Modern Analyst but kept it quiet. His own beautiful papers on countertransference are, to my mind, clearly anchored in the spirit of Spotnitz’s work. Years later, when he received a Lifetime Achievement Award from the Psychoanalytic Psychotherapy Study Center, Epstein acknowledged that he worked fully as a Modern Analyst. (PPSC was the first and still the only multi-orientational institute that includes Modern Psychoanalysis as a full part of its curriculum, making it the only real bridge between Modern Analysis and the current psychoanalytic mainstream.)
This second recording is an interview with Dr. Larry Epstein. The sound quality is also equally bad for the same reasons: poor recording equipment and a loud air conditioner on an equally hot summer day. This interview was my only contact with him.
What Was Therapeutic About Spotntiz?
Robert Marshall, PhD
This is a previously unpublished article by Robert Marshall, the author of Resistant Interactions and co/author (with Simone Marshall) of The Transference Countertransference Matrix: The Cognitive Emotional Dialogue in Psychotherapy, Psychoanalysis, and Supervision, and many, many articles on topics ranging from Spotnitz’s relationship with Hungarian psychoanalysts to the relationship of transference to fractal theory. He is also one of the few Modern Analysts who was always in dialogue with analysts outside of the world of Modern Psychoanalysis. He worked with Spotnitz for nearly 50 years, and this brief article, which displays his characteristic concision and precision, combines personal experience with reports of other patients and gives examples of micro-therapeutic moments that constitute the turning points yet also manages to generalize them in just three pages.
