Modern psychoanalysis

Modern psychoanalysis is the term used by Hyman Spotnitz to describe the techniques he developed for the treatment of narcissistic disorders.

Narcissism is understood (by Spotnitz) as a state in which unexpressed aggression and hostility are trapped within the psychic apparatus with corrosive effects on mind and body. The bottled up aggression is turned against the self by a weak and undeveloped ego that is not capable of handling the stress of hateful feelings. The techniques of modern psychoanalysis are aimed at allowing the ego to direct aggression outward in productive ways and at protecting a fragile ego against the self-attack seen in cases ranging from schizophrenia, depression, and somatization to neurotic forms of self-sabotage. This is accomplished by helping the patient to "say everything."

The ego is protected by what is called "object oriented questions." These are questions directed toward the motives of other people rather than the patient, i.e., "What makes her do that?" or, "Why did I do that?” To guide the quality and number of such interventions modern analysts follow the "contact function," the efforts made by the patient to establish some discourse with the analyst. Questions asked by the patient indicate what the patient is ready to talk about and are explored to help the patient say more. Meadow describes the contact function as responding, "’in kind,’ thus replacing subjectively determined timing as used in traditional insight-oriented interpretation with what might be called ‘demand feeding’.

In the interest of helping patients to say everything while functioning at an optimum level, the analyst refrains from interpreting defenses and instead "joins the resistance.” In joining, the analyst conveys acceptance of the patient's thoughts and feelings, stated or unstated, conscious or unconscious. Joining reduces the need for a particular defense by making the patient less defensive.

Although modern analysis forgoes interpretation as the main form of intervention, it retains the classical psychoanalytic focus on transference, countertransference, and resistance. The transference is usually a narcissistic one in which feelings and patterns of defense from the first years of life are revived. The "narcissistic transference" is not so much a projection of figures from the past onto the analyst, as an externalization of parts of the patient's self. Often a benign feeling of oneness with the analyst prevails at the beginning of treatment. Such patients may make little or no contact with the analyst.

Modern analysts find that narcissistic transference develops in all patients, and to facilitate its full expression they recommend that the analyst not attempt to correct the patient’s perceptions which would emphasize the differences between patient and analyst, undermining their narcissistic connection. Since patients who are struggling with bottled-up rage often hate themselves, they are apt to hate the analyst as well. The transference, which binds them to the therapist, permits the expression of feelings patients cannot own. In the negative narcissistic transference, they hate the analyst as they hate themselves. When the analyst is seen as an extension of the self, aggression may be more freely and safely expressed, lessening patients’ self-hatred and allowing them to slowly emerge from their narcissistic state.

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