Monday, May 14, 2012

Intersubjective Systems Theory in Psychoanalysis - An Overview

George E. Atwood, Robert D. Stolorow, and Donna M. Orange are the core theorists of intersubjective systems theory, a form of psychoanalytic practice that focuses on the relational origins of mental distress and does so through the interpersonal and intersubjective relationship of the analyst and analysand. 

These theorists, all of whom are practicing psychoanalysts, have rejected the Cartesian version of self as a unitary, isolated entity, and have likewise rejected mental illness as an intrapsychic dysfunction. In their model, which relies heavily on phenomenological philosophy as its explanatory foundation, the patient's troubles (excluding organic disease or physical trauma) exist only within the experiential and relational contexts in which they developed.

There are two powerful and often implicit beliefs that underlie most current psychotherapeutic models: (1) the Myth of Modeling, "a way of thinking which over-emphasizes the conscious, cognitive, rational and technique based aspects of the psychoanalytic encounter" (Mikko Martela and Esa Saarinen, 2008), and (2) the Myth of the Isolated Mind (Stolorow and Atwood 2002), a remnant of the Cartesian dualism that has infected Western philosophy until the middle of the 20th Century and still is embedded in modern psychology.

Intersubjective systems theory (IST, or intersubjectivity theory) proposes that minds are not isolated, unitary things that exist as individual entities, as though in a vacuum. Rather, minds exist within interpersonal and intersubjective relationships, beginning at birth (and even before) with the attachment bond to the mother, and they develop within interpersonal, intersubjective, relational contexts. 

Here is a wide-angle definition of intersubjectivity from Alex Gillespie and Flora Cornish (2009):

Gillespie, A. & Cornish, F. (2009). Intersubjectivity: Towards a Dialogical Analysis. Journal for the Theory of Social Behaviour, 40:1; 20-46.

Intersubjectivity is central to the social life of humans. Thus, unsurprisingly, research pertaining, either directly or indirectly, to intersubjectivity spans many research areas of psychology. In developmental psychology it lies just below the surface of widely used concepts such as decentration (Piaget & Inhelder, 1969), theory of mind (Doherty, 2008) and perspective taking (Martin, Sokol and Elfers, 2008). In neuroscience, intersubjectivity has recently become a popular topic with the discovery of “mirror neurons” which are thought to provide a neurological basis for imitation, theory of mind, language, and social emotions (Hurley & Chater, 2005). In the field of comparative psychology, there has been a surge of interest in intersubjectivity, in the form of investigations of possible perspective-taking amongst, for example, monkeys (Tomasello, Call and Hare, 2003) and scrub jays (Emery & Clayton, 2001). Intersubjectivity, going by various names, is also central to research on communication. Phenomena such as addressivity, double voiced discourse, and dialogue are deeply intersubjective (Linell, 2009). Intersubjectivity has also been identified as important in small group research because it has been found that mutual understanding within small groups creates increased efficiency, reliability and flexibility (Weick & Roberts, 1993). Research on self and identity has long emphasised the importance of Self’s perceptions of Other’s perceptions of Self (James, 1890; Howarth, 2002). In the field of counselling, much therapeutic effort is directed at resolving misunderstandings and feelings of being misunderstood both of which indicate dysfunctional intersubjective relations (Cooper, 2009). (p. 20)
Unfortunately, intersubjective theory falls into an area of overlap between psychology and sociology, and the insularity of each has precluded any serious cooperation in terms of research. Most of the research has been done in the realm of psychology and philosophy (especially by Stolorow and Orange).

Peter Buirski (Practicing Intersubjectively, 2005) offers a concise explanation of mind as understood by IST:
Mind, as understood by current developmental research, is a relational construction. As we have discussed previously, there is no subjectivity without intersubjectivity and there can be no intersubjectivity without subjectivity (Buirski and Haglund, 2001). That is, subjective worlds of personal experience are inextricably embedded in intersubjective systems. When viewed from a systems or contextual perspective, distinctions, like those between one-person and two-person psychologies, are revealed as too limited because worlds of personal experience encompass more than just the two people involved. (p. 4)

Kenneth Gergen (Relational Being: Beyond Self and Community, 2009) offers another way of looking at this, specifically at the therapeutic relationship within a relational context.
We now turn to the therapeutic relationship itself. From the present standpoint, how are we to understand the relationship between therapist and client, its potentials, and its efficacy? In responding to this question, we are invited to think beyond the tradition of bounded being in which the aim of therapy is to "cure" the mind of the individual client. The metaphors of the therapist as one who "plumbs the depths," or serves as a mechanic of the cognitive machinery must be bracketed. We also set aside the causal model in which the therapist acts upon the client to produce change. Rather, we are invited to view the therapist and client as engaged in a subtle and complex dance of co-action, a dance in which meaning is continuously in motion, and the outcomes of which may transform the relational life of the client.
Consider the situation: Both therapist and client enter the therapeutic relationship as multi-beings. Both carry with them the residues of multiple relationships. Therapists bring not only a repertoire of actions garnered from their history of therapeutic relations; they also carry potentials from myriad relations stretching from childhood to the present. Likewise, clients enter carrying a repertoire of actions, some deemed problematic, but alongside a trove of less obvious alternatives. The primary question, then, is whether the process of client/therapist coordination can contribute to a transformation in relationships of extended consequence. Can their dance together reverberate across the client's relational plane in such a way that more viable coordination results? This is no small challenge, for the client's plane of relationships is complex and fluid. (p. 282, Kindle Edition)
Much of IST is based in philosophy. Stolorow and his collaborators believe that in order to make sense of the therapeutic relationship, we need make objects of our subjective beliefs about the mind. If we believe in a unitary, isolated mind, we are going to relate to our clients as objects to be fixed, to see their pain as faulty scripts that we have the expertise to reprogram.

But if we believe in the social construction of mind within its physical, intrapsychic, intersubjective, and environmental contexts, then we are more likely to approach the client with a relational and co-constructive perspective on the therapeutic process, where healing comes from relationship and process (for example, the co-transference process).

This is how they explain the need for self-analysis:

Atwood, G.E., Stolorow, R.D. & Orange, D.M. (2011, Jun). The Madness and Genius of Post-Cartesian Philosophy: A Distant Mirror. Psychoanalytic Review, 98(3), 263-285.
In studying the psychological sources of philosophical ideas, we go against a pervasive opinion in contemporary intellectual circles that is rooted in Cartesianism. This opinion, perhaps surprising in its prevalence so long after the life and death of Descartes, arises from a continuing belief—one could almost say a mystical faith—in the autonomy of the life of the mind. The products of the mind are in this view to be treated as independent, self-sufficient creations, verified, falsified, or otherwise evaluated according to criteria that exist apart from the personal contexts out of which they arise. Any attempt to bring considerations of origin to bear on the understanding and development of intellectual works is seen to exemplify the unforgivable fallacy of ad hominem reasoning. It is therefore said that the study of the individual details of a thinker’s life, although perhaps of some limited interest as simple biography, can in principle have no relevance to the broader enterprise of the development or evaluation of that thinker’s work in its own terms. Intellectual constructions are claimed to have a life of their own, freely subsisting in the realm of public discourse, above and beyond the historical particularities of specific contributors’ personal life circumstances. (p. 264)

Our thesis here is that the task of self-analysis must be extended to the philosophical premises underlying psychoanalytic inquiry which, like all specific theoretical ideas in the field, also necessarily embody the analyst’s personal forms of being. Our approach to this great task is to study the individual worlds of selected post-Cartesian philosophers, with the aim of comprehending the psychological sources of each thinker’s specific repudiation of Cartesian doctrines. We hope to use the insights gained in this study as a distant mirror to which we may turn for a clarifying glimpse of how our own departures from the Cartesian view also reflect the patterns of our specific personal worlds. It is our additional faith that such an undertaking of self-reflection carries with it the possibility of the opening up of new pathways of inquiry for our discipline and the enrichment of psychoanalytic practice. (p. 266-267)
The following quotes are from Stolorow (in an interview) on the practice of IST in a clinical setting, which is it becomes useful for me as a clinician. It is important to note that there is no uniform body of technique to which all proponents of ITS adhere, nor is there any standardized or manualized series of interventions. If there is one thing upon which they all agree it's that every treatment is unique and must be created anew by its participants. So even Stolorow is only speaking for himself here, not for all the other advocates for ITS. 

Stolorow, R., & Sassenfeld, A. (2010, Summer). A Phenomenological-Contextual Psychoanalyst: Intersubjective-Systems Theory and Clinical Practice. Psychologist-Psychoanalyst: APA Division 39, Psychoanalysis; 6-10.

I describe intersubjective-systems theory as a "phenomenological contextualism." It is phenomenological in that it investigates organizations or worlds of emotional experience. It is contextual in that it claims that such organizations of emotional experience take form, both developmentally and in the therapeutic situation, in constitutive intersubjective contexts.
Developmentally, recurring patterns of intersubjective transaction within the developmental system give rise to principles that unconsciously organize subsequent emotional and relational experiences. Such unconscious organizing principles are the basic building blocks of the personality. They show up in the therapeutic situation in the form of transference, which intersubjective systems theory conceptualizes as unconscious organizing activity. The patient's transference experience is co-constituted by the patient's unconscious organizing principles and whatever is coming from the analyst that is lending itself to being organized by them. A parallel statement can be made about the analyst's transference. The interplay of the patient's transference and the analyst's transference is an example of what we call an intersubjective field or system.

From an intersubjective-systems perspective, all of the clinical phenomena with which psychoanalysis has been traditionally concerned: manifest psychopathology, transference, resistance, therapeutic impasses, therapeutic action, emotional conflict, indeed, the unconscious itself are seen as taking form within systems constituted by the interplay between differently organized, mutually influencing subjective worlds. (p. 6)

And more from the 2010 interview with Sassenfeld:
One's philosophical presuppositions, and one's awareness or unawareness of them, can have a monumental clinical impact. For example, the Cartesian objectivist analyst who sees himself/herself as treating deranged isolated minds and correcting "distortions" of what he/she "knows" to be true can unwittingly retraumatize his/her patients by repeating devastating early experiences of massive invalidation. On the other hand, the phenomenological-contextualist analyst, in seeking to understand and make sense out his/her patients' experiences in terms of the contexts of meaning in which they occur, no matter how bizarre these experiences may seem to be, helps to create a therapeutic bond in which genuine psychological transformation can gradually take place. (p. 6-7)

But this does not lead inevitably to some form of navel-gazing relativism.
A phenomenological, contextualist, perspectivalist stance, although embracing a fallibilistic attitude of epistemological humility and a level epistemological playing field in the therapeutic situation (no one has privileged access to truth and reality), should not be confused with postmodern nihilism or relativism. Relativity to context and to perspective is not the same thing as a relativism that considers every framework to be as good as the next. Pragmatically, some ideas are better than others in facilitating psychoanalytic inquiry and the psychoanalytic process. Moreover, we do not abandon the search for truth, that is, for lived experience.

Intersubjectivity theory holds that closer and closer approximations of such truth are gradually achieved through a psychoanalytic dialogue in which the domain of reflective awareness is enlarged for both participants. Truth, in other words, is dialogic, crystallizing from the inescapable interplay of observer and observed.

My own phenomenological orientation did not, by the way, originate in Kohut's self psychology. Its origins go back to a series of studies that George Atwood and I conducted in the early and mid-1970s investigating the personal subjective origins of four psychoanalytic theories. These studies were collected together in our first book, Faces in a Cloud, which was completed in 1976 (although not published until 1979), one year prior to the birth of Kohut's self psychology. In the concluding chapter of our book, we reasoned that, since psychoanalytic theories can be shown to a significant degree to be shaped by the personal subjectivity of their creators, what psychoanalysis needs to be is a theory of subjectivity itself--a depth psychology of personal experience broad enough to encompass, not only the phenomena that other theories address, but also these theories themselves. We christened pur proposed framework "Psychoanalytic Phenomenology," but that appellation never caught on. It was that framework that gradually evolved into intersubjective-systems theory.

A phenomenological emphasis does not in anyway entail abandonment of the exploration of unconsciousness. Going back to the father of philosophical phenomenology; Edmund Husserl, phenomenological inquiry has never been restricted to mere description of conscious experiences. Phenomenological investigation has always been centrally concerned with the structures that unconsciously organize conscious experience. Whereas philosophical phenomenologists are concerned with those structures that operate universally, a psychoanalytic phenomenologist seeks to illuminate those principles that unconsciously organize individual worlds of experience. Such principles include, importantly, those that dictate the experiences that must be prevented from coming into full being, that is, repressed, because they are prohibited or too dangerous. Intersubjective-systems theory emphasizes that all such forms of unconsciousness are constituted in relational contexts. The very boundary between conscious and unconscious (the repression barrier) is seen, not as a fixed intrapsychic structure within an isolated mind, but as a property of ongoing dynamic intersubjective systems. Phenomenology leads us inexorably to contextualism. (p. 7)
One of the key phrases, coming originally from Donna Orange, that explains ITS is "making sense together." In fact, Peter Buirski and Pamela Haglund used it for the title of their book (Making Sense Together: The Intersubjective Approach to Psychotherapy, 2001).
According to Orange (1995, p. 8), "Intersubjectivity theory sees human beings as organizers of experience, as subjects. Therefore it views psychoanalytic treatment as a dialogic attempt of two people to understand one person's organization of emotional experience by 'making sense together' of their shared experience" (p. 26)
Another note of clarification is needed here. Although ITS makes a point of the co-transference and the co-creation on the intersubjective space, there is not full equality in the relationship. I, as the therapist, am talking less than my client and offering questions, clarifications, or interpretations when I do speak, while the client is telling me the story of who s/he is and how it feels to be in that subjective space. 

In practice, what a ITS psychotherapist says in a session may look no different than what any experienced psychotherapist might say in a session. Buirski (2005) notes:
I try to articulate my grasp of the other's subjective world of experience, which is what I believe most good therapists, regardless of theory, do most of the time. Perhaps the difference lies in the inverse: what distinguishes the therapist working from the intersubjective systems perspective from the therapists working from other orientations is to be found more in what they do not do or say than in what they actually do or say. For example, we try to avoid taking an objectivist stance, assuming that we are privy to some greater authority or knowledge than the other. And we avoid pathologizing, which is revealed by a focus on the person's maladaptive behaviors or motives, like his masochism. Instead we wonder about how the person's striving for health might be obscured by behaviors or motives that appear self-defeating. (xvi-xvii). 

Finally, the following comments from Stolorow come from a 1998 article/response to another author (George Frank) who had raised objections to the ITS model. This piece is an attempt to explain the foundational ideas of intersubjective systems theory more clearly (and to discredit the critic). Stolorow and his collaborators were getting a lot of push-back from more traditional psychoanalytic therapists who thought they were staging a coup (they were, really, bringing a whole new perspective into the psychoanalytic and therapeutic equation). There are many similar articles from the 1990s, including some from Donna Orange, as well.

Stolorow, R.D. (1998). Clarifying the intersubjective perspective: A reply to George Frank. Psychoanalytic Psychology, 15(3), 424-427. doi: 10.1037/0736-9735.15.3.424

In response to Frank, G. (1998). The intersubjective school of psychoanalysis: Concerns and questions. Psychoanalytic Psychology, 15(3), 420-423. doi:10.1037/0736-9735.15.3.420

I have quoted almost all of the article since it was short and the material is less coherent without the full context.
First, the collaborators of intersubjectivity theory have not sought to create yet another "school of psychoanalysis," if what is meant by that phrase is a fixed metapsychological doctrine with accompanying rules of technique. Rather, the intersubjective perspective offers a unifying framework for conceptualizing psychoanalytic work of all theoretical schools. The hallmark of our viewpoint is a clinical sensibility emphasizing "the inescapable interplay of observer and observed" (Orange, Atwood, & Stolorow, 1997, p. 9). It is not our aim to have our theory replace Freud's "as the theory that can explain the psychological life of humans" (Frank, 1998, p. 420). On the contrary, intersubjectivity theory exists at a different level of abstraction and generality than does Freud's and other psychoanalytic theories, in that it does not posit particular psychological contents that are presumed to be universally salient in personality development and in pathogenesis. It is a process theory offering broad methodological and epistemological principles for investigating and comprehending the intersubjective contexts in which psychological phenomena, including psychoanalytic theories (Atwood & Stolorow, 1993), arise. It also provides a framework for integrating different psychoanalytic theories by contextualizing them. From an intersubjective perspective, the content themes of various metapsychological doctrines can be de-absolutized, de-universalized, and recognized as powerful metaphors and imagery that can become salient in the subjective worlds of some people under particular intersubjective circumstances (Orange et al., 1997).

Second, we have never made the absurd claim, which Frank attributed to us, that "there is no objective reality" (Frank, 1998, p. 421). We have instead consistently maintained that objective reality is unknowable by the psychoanalytic method, which investigates only subjective reality as it crystallizes within the intersubjective field of an analysis. Frank was correct when he concluded that from our point of view the analyst has no privileged access to "what is really going on between patient and analyst." All psychoanalytic understanding is interpretive. This means that there are no neutral or objective analysts, no immaculate perceptions, no God's-eye views of anything. Intersubjectivity theory holds that closer and closer approximations of "what is really going on" are gradually achieved through an analytic dialogue in which the domain of reflective selfawareness is enlarged for both participants. There is no danger of solipsism or of relativism here, only a contextual, perspectival, and fallibilistic epistemology (Orange, 1995) that consistently "opens our horizons to expanded possibilities of meaning" (Orange et al., 1997, p. 89).

Third, Frank was incorrect when he inferred that our intersubjective contextualism means that we "have moved away from" (Frank, 1998, p. 422) our focus on the invariant principles that unconsciously organize experience:
Some may see a contradiction between the concept of developmentally preestablished principles that organize subsequent experiences and our repeated contention that experience is always embedded in a constitutive intersubjective context. This contradiction is more apparent than real. A person enters any situation with an established set of ordering principles (the subject's contribution to the intersubjective system), but it is the context that determines which among the array of these principles will be called on to organize the experience. Experience becomes organized by a particular invariant principle only when there is a situation that lends itself to being so organized. The organization of experience can therefore be seen as codetermined both by preexisting principles and by an ongoing context that favors one or another of them over the others. (Stolorow & Atwood, 1992, p. 24)
Fourth, Frank confused the aim of analysis with the method of analysis when he mistakenly concluded that we advocate "analyzing] the interaction between patient and analyst to understand the nature of that interaction" (Frank, 1998, p. 422). From our perspective, the aim of an analysis has always been the illumination of the patient's world of personal experience, but the method of investigation must continually take into account its own exquisite context sensitivity:
The development of psychoanalytic understanding may be conceptualized as an intersubjective process involving a dialogue between two personal universes. The goal of this dialogue is the illumination of the inner pattern of a life, that distinctive structure of meanings that connects the different parts of an individual's world into an intelligible whole. The actual conduct of a psychoanalysis . . . comprises a series of empathic inferences into the structure of an individual's subjective life, alternating and interacting with the analyst's acts of reflection upon the involvement of his own personal reality in the ongoing investigation. (Atwood & Stolorow, 1984, p. 5)
[Intersubjectivity theory] views psychoanalysis as the dialogic attempt of two people together to understand one person's organization of emotional experience by making sense together of their intersubjectively configured experience. (Orange et al., 1997, p. 5)
Fifth, contrary to Frank's misperception, there is nothing in our view of psychoanalytic investigation that could result in "ignoring the patient's history" (Frank, 1998, p. 423):
Clinically, we find ourselves, our patients, and our psychoanalytic work always embedded in constitutive process. Process means temporality and history. To work contextually is to work developmentally. To work developmentally is to maintain a continuing sensibility to past, present, and future experience.... [It] affirms the emotional life of persons who have come from somewhere and are going somewhere. (Orange et al., 1997, p. 77)
Sixth, it is clear, I hope, that Frank (1998) seriously mischaracterized our views when he claimed that we "abandon" the intrapsychic world or adopt "an extreme position contra Freud's intrapsychic orientation" (p. 423). I close with an explicit statement of our position on this matter:
We must emphasize, because we are often misunderstood on this point [!], that the intersubjective viewpoint does not eliminate psychoanalysis's traditional focus on the intrapsychic. Rather, it contextualizes the intrapsychic. The problem with classical theory was not its focus on the intrapsychic, but its inability to recognize that the intrapsychic world, as it forms and evolves within a nexus of living systems, is profoundly context-dependent. (Orange et al., 1997, pp. 67-68)

Additional References:

Buirski, P. & Haglund, P. (2001). Making Sense Together: The Intersubjective Approach to Psychotherapy. Lanham, MD: Jason Aronson.

Buirski, P. (2005). Practicing Intersubjectively. Lanham, MD: Jason Aronson.

Gergen, K. (2009). Relational Being: Beyond Self and Community. NY: Oxford University Press.

Martela, M. & Saarinen, E. (2008). Overcoming the objectifying bias implicit in therapeutic practice – Intersubjective Systems Theory complemented with Systems Intelligence. Unpublished manuscript.

Stolorow, R.D. & Atwood, G.E. (2002). Contexts of Being: The Intersubjective Foundations of Psychological Life. Analytic Press, Hillsdale, NJ.
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