July 24, 2017History of Medicine
Freudian psychoanalytic theory spawned other creative approaches to the practice of psychoanalysis, which built upon Freud's theories of psychic development.
Object Relations and The Basic Fault
Michael Balint (1896-1970) was a Hungarian psychoanalyst who spent most of his adult life in England. He was a proponent of the Object Relations school.
Balint was born Mihaly Maurice Bergsmann, the son of a practicing physician in Budapest. It was against his father's will that he changed his name to Balint Mihaly. He also changed religion, from Judaism to Unitarian Christianity. During World War I Balint served at the front, first in Russia, then in the Dolomites. He completed his medical studies in Budapest in 1918. On the recommendation of his future wife, Alice Szekely-Kovacs, Balint read Sigmund Freud's Drei Abhandlungen zur Sexualtheorie (1905) and Totem und Tabu. He also began attending the lectures of Sandor Ferenczi, who in 1919 became the world's first university professor of psychoanalysis. In 1920, Balint married and then moved to Berlin, where he worked in the biochemical laboratory of Otto Heinrich Warburg (1883-1970), who won the Nobel Prize in 1931. Balint worked on his doctorate in biochemistry, while also working half time at the Berlin Institute of psychoanalysis. In 1924 the Balints returned to Budapest, where he assumed a leading role in Hungarian psychoanalysis. During the 1930s the political conditions in Hungary made the teaching of psychotherapy practically impossible, and they emigrated to London in 1938, settling in Manchester, England. In early 1939, Balint became Clinical Director of the Child Guidance Clinic. In 1944, his parents, about to be arrested by the Nazis in Hungary, committed suicide. That year Balint moved from Manchester to London, where he was attached to the Tavistock Clinic and began learning about group work from W.R. Bion; he also obtained the Master of Science degree in psychology. In 1949, Balint became the leader of the Tavistock Institute of Human Relations and developed what is now known as the Balint group: The Balint Group consisted of a group of physicians sharing the problems of general practice, in particular, focusing on the responses of the doctors to their patients. This first group of practicing physicians was established in 1950. In 1968 Balint became president of the British Psychoanalytical Society.In Hamburg, Germany, The Michael-Balint-Institut fur Psychoanalyse, Psychotherapie und analytische Kinder- und Jugendlichen- Psychotherapie is named for him.
Balint took an early interest in the mother-infant relationship, a key paper on Primary Object-Love was received with approval by other Freudian psychoanalysts. One respected psychoanalyst wrote that Michael Balint has analyzed in a thoroughly penetrating way the intricate interaction of theory and technique in the genesis of a new conception of analysis, of a two-body psychology. On that basis, Balint explored the idea of what he called the basic fault: this was that there was often the experience in the early two-person relationship that something was wrong or missing, and this carried over into the Oedipal period (age 2-5). By 1968, then, Balint had distinguished three levels of experience, each with its particular ways of relating, its own ways of thinking, and its own appropriate therapeutic procedures. Balint's three person or level 3, was the level at which a person is capable of a three-sided experience, primarily the Oedipal problems between self, mother, and father'. By contrast, 'the area of the Basic Fault is characterized by a very peculiar exclusively two-person relationship'; while a 'third area is characterized by the fact that there are no external objects in it - level number 1.
Therapeutic failure is attributed by Balint to the analyst's inability to click in to the mute needs of the patient who has descended to the level of the basic fault; and he maintained that the basic fault can only be overcome if the patient is allowed to regress to a state of oral dependence on the analyst and experience a new beginning. Balint developed a process of brief psychotherapy he termed focal psychotherapy, in which one specific problem presented by the patient is chosen as the focus of interpretation. The therapy was carefully targeted around that key area to avoid (in part) the risk that the focal therapy would have degenerated into long-term psychotherapy or psychoanalysis. Here as a rule interpretation remained 'entirely on the whole-person adult level, it was the intention to reduce the intensity of the feelings in the therapeutic relationship. In accordance with the thinking of other members of what is known as the British independent perspective, such as W. R. D. Fairbairn and D. W. Winnicott, great stress was laid upon the creative role of the patient in focal therapy: To our minds, an independent discovery by the patient has the greatest dynamic power. It has been suggested that it was in fact this work of Michael Balint and his colleagues which led to time-limited therapies being rediscovered.
Michael Balint as part of the independent tradition in British psychoanalysis, was influential in setting up groups (now known as Balint groups) for medical doctors to discuss psychodynamic factors in relation to patients. Instead of repeating futile investigations of increasing complexity and cost, Balint taught active search for causes of anxiety and unhappiness, and treatment by remedial education aiming at insight by the patient. Such seminars provided opportunities for GPs to discuss with each other and with him aspects of their work with patients for which they had previously felt ill equipped. Since his death the continuance of this work has been assured by the formation of the Balint Society.
Psychoanalysis and Low Dose LSD
The term anaclitic (from the Greek anaklinein - to lean upon) refers to various early infantile needs and tendencies directed toward a pregenital love object. This method was developed in the 1950s by two London Freudian psychoanalysts, Joyce Martin MD and Pauline McCririck MD. It is based on clinical observations of deep age regression occurring in LSD sessions of psychiatric patients. During these periods many of them relive episodes of early infantile frustration and emotional deprivation. This is typically associated with agonizing cravings for love, physical contact, and other instinctual needs experienced on a very primitive level. The technique of LSD therapy practiced by Martin and McCririck was based on psychoanalytic understanding and interpretation of all the situations and experiences occurring in drug sessions and in this sense is very close to psycholytic approaches. The critical difference distinguishing this therapy from any other was the element of direct satisfaction of anaclitic needs of the patients. In contrast to the traditional detached attitude characteristic of psychoanalysis and psycholytic treatment, Martin and McCririck assumed an active mothering role and entered into close physical contact with their patients to help them to satisfy primitive infantile needs reactivated by the drug.
More superficial aspects of this approach involve holding the patients and feeding them warm milk from a bottle, caressing and offering reassuring touches, holding their heads in one's lap, or hugging and rocking. The extreme of psycho-dramatic involvement of the therapist is the so-called fusion technique, which consists of full body contact with the client. The patient lies on the couch covered with a blanket and the therapist lies beside his or her body, in close embrace, usually simulating the gentle comforting movements of a mother caressing her baby. The subjective reports of patients about these periods of fusion with the therapist are quite remarkable. They describe authentic feelings of symbiotic union with the nourishing mother image, experienced simultaneously on the level of the good breast and good womb. In this state, patients can experience themselves as infants receiving love and nourishment at the breast of the nursing mother and at the same time feel totally identified with a fetus in the oceanic paradise of the womb. This state can simultaneously involve archetypal dimensions and elements of mystical rapture, and the above situations be experienced as contact with the Great Mother or Mother Nature. It is not uncommon that the deepest form of this experience involves feelings of oneness with the entire cosmos and the ultimate creative principle, or God. The fusion technique seems to provide an important channel between the psychodynamic, biographical level of the LSD experience and the transcendental states of consciousness. Patients in anaclitic therapy relate that during their nourishing exchange with the mother image, the milk seemed to be coming directly from the Milky Way. In the imaginary re-enactment of the placentary circulation the life-giving blood can be experienced as sacramental communion, not only with the material organism, but with the divine source. Repeatedly, the situations of fusion have been described in all their psychological and spiritual ramifications as fulfillment of the deepest needs of human nature, and as extremely healing experiences. Some patients described this technique as offering the possibility of a retroactive intervention in their deprived childhood. When the original traumatic situations from childhood become reenacted in all their relevance and complexity with the help of the psychedelic time-machine, the therapist's affection and loving care can fill the vacuum caused by deprivation and frustration.
The dosages used in this treatment technique ranged between 100 and 200 micrograms of LSD, sometimes with the addition of Ritalin in later hours of the sessions. Martin and McCririck described good and relatively rapidly achieved results in patients with deep neuroses or borderline psychotic disorders who had experienced severe emotional deprivation in childhood. Their papers, presentations at scientific meetings, and a film documenting the anaclitic technique stirred up an enormous amount of interest among LSD therapists and generated a great deal of fierce controversy. The reactions of colleagues to this treatment modality ranged from admiration and enthusiasm to total condemnation. Since most of the criticism from the psychoanalytically oriented therapists revolved around the violation of the psychoanalytic taboo against touching and the possible detrimental consequences of the fusion technique for transference-countertransference problems, it is interesting to describe the authors' response to this serious objection. Both Martin and McCririck seemed to concur that they had experienced much more difficulty with transference relationships before they started using the fusion technique. According to them, it is the lack of fulfillment in the conventional therapeutic relationship that foments and perpetuates transference. The original traumatic situations are continuously reenacted in the therapeutic relationship and the patient essentially experiences repetitions of the old painful rejections. When the anaclitic needs are satisfied in the state of deep regression induced by the drug, the patients are capable of detaching themselves emotionally from the therapist and look for more appropriate objects in their real life. This situation has a parallel in the early developmental history of the individual. Those children whose infantile emotional needs were adequately met and satisfied by their parents find it relatively easy to give up the affective ties to their family and develop independent existence. By comparison, those individuals who experienced emotional deprivation and frustration in childhood tend to get trapped during their adult life in symbiotic patterns of interaction, destructive and self-destructive clinging behavior, and life-long problems with dependence-independence. According to Martin and McCririck, the critical issue in anaclitic therapy is to use the fusion technique only during periods of deep regression, and keep the experience strictly on the pregenital level. It should not be used in the termination periods of the sessions when the anaclitic elements could get easily confused with adult sexual patterns.
The anaclitic technique never achieved wide acceptance; its use seemed to be closely related to unique personality characteristics in its authors. Most other therapists, particularly males, found it emotionally difficult and uncomfortable to enter into the intimate situation of fusion with their clients. However, the importance of physical contact in LSD psychotherapy is unquestionable and many therapists have routinely used various less-intense forms of body contact.
Sources: History of LSD Therapy by Stanislav Grof, M.D.; Wikipediaa