Being of Two Minds: The Vertical Split in Psychoanalysis and Psychotherapy
Being of Two Minds: The Vertical Split in Psychoanalysis and Psychotherapy
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两种思想的存在：精神分析和心理治疗的垂直分裂
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发表时间：
2000
期刊：
影响因子：
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通讯作者：
S. Karterud
中科院分区：
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作者：
S. Karterud
回顾阿诺德·戈德堡的新书《两种思想的存在》并不容易。它激发了我的学术部分，也挑战了我的临床部分。这本书涉及否定，并详细阐述了垂直分裂的主题，正如科胡特在《自我分析》（1971）中首次提出的那样。学术部分希望对否认和垂直分裂的概念有更精确的定义，而不是其他防御机制，并参考研究文献。特别是，我的学术部分不同意戈德堡对“分离”一词的使用。我还发现Kohut对自恋型人格障碍和自恋型行为障碍的区分，戈德堡将其延续了下去，在现代人格障碍知识的背景下，这种区分有点过时了。
Reviewing Arnold Goldberg's new book Being of Two Minds has not been easy. It has provoked the academic part of me and challenged the clinical part. The book deals with disavowal and elaborates on the theme of vertical split, as first formulated by Kohut in The Analysis of the Self (1971). The academic part would have liked more precise definitions of the concepts of disavowal and vertical split, as opposed to other defense mechanisms, and references to the research literature. In particular, my academic part was not in agreement with Goldberg's use of the term dissociation. I also found Kohut's distinction, which Goldberg perpetuates, between narcissistic personality disorders and narcissistic behavior disorders a bit outdated in the light of modern knowledge of personality disorders.
However, my clinical part was increasingly engaged and challenged during the reading of Goldberg's book—so much so that it influenced my clinical practice. One episode was the following: a man (age 38) with an avoidant personality disorder had recently reported in an analytic group a dream where he invited me to his home, but when his father turned up my patient became embarrassed by my presence and tried to hide me behind his back. In this group meeting, several group members had pointed out his massive self- devaluation and avoidance of pride for his achievements. He started to talk in a monotonous and intellectualizing manner about his father. A real event this same morning was a picture of and an interview with me in the most influential Norwegian newspaper. Some side conversations at the beginning of the session signaled that the group members had read it. In a slight pause in the monologue about the father, I asked: “What do you think about the newspaper interview with me this morning?” When I said this, Goldberg's writings on boundary incidents were in my mind. I also noted a slight anxiety in myself. With this in mind, I was able to address a variety of transferences, ranging from identification and pride to feelings of loss and anger. Toward the end, the above-mentioned patient movingly exposed new aspects of his idealization of me, which symbolically meant a lesser need to hide me behind his back.
I am grateful to Goldberg for inspiration from his description of the vertical split, which led to my better appreciation of the following comments in another group: Mr. E. tells about childhood memories and says: “It's a strange feeling. It's like seeing a series of paintings being lined up on the floor against the wall.” Miss L.: “The first time in the group when I talked about my mother's alcoholism, I was observing myself talking. Was this me talking this way?” Miss B.: “When you [the therapist] talk to me this way about my youth, I acknowledge in some sense the truth in what you are saying, yet still I think, Is this me? It is as if aspects of me and my past are unreal and have to be mirrored by others before I can own them myself.” And Miss C. about a new sense of integration: “I visited my childhood home this weekend. A strange experience. It was as if it previously had been in black and white, in a shadow. Now all the things were filled with colors, substance, smells, and condensed with memories. The picture of my father was there. I've seen it a thousand times. Yet it was like I never had really seen it before, until now.”
Goldberg's text deals extensively with the type of vertical split that involves shameful (and disavowed) misbehavior. While reading this book I realized that it was as much about moral courage as it was about defense mechanisms. Or better, it addressed the difficult meeting point of repetition compulsion, freedom of choice, and moral responsibility. Goldberg beautifully describes how split-off parts of the self develop as spaces for acting out within the family matrix, where such acting out is silently (unconsciously) accepted while at the same time condemned. When a person enters the patient role, the same scenario will be created in the transference. There is an unconscious expectation that the therapist will condemn split-off parts (e.g., misbehavior) yet at the same time engage in a silent conspiracy of not taking them seriously enough to talk about. This splitting comes into treatment through stories containing extremely shameful incidents or in ones describing boundary incidents.
The most challenging aspect of Goldberg's book is his descriptions and explanations of countertransference reactions. Vertical splits challenge our ethics and morality. How committed are we as therapists to the long-term goals of psychoanalytic psychotherapy? Is the ideal of an integrated, morally responsible person and citizen outdated in this postmodern age? Isn't it possible to live well with a moderate amount of infidelity and tax cheating and occasional pot smoking? That may be, but the problem is whether a moral laxity in the therapist corrupts the moral means whereby the ethical aims of analysis are achieved. According to Goldberg, a high level of personal integration and moral courage from the therapist is necessary for the treatment of vertical splits. Unless one knows the thief, the liar, the pervert, the grandiose Nobel prize winner inside oneself as therapist, the chances are high for unconscious collusions that serve to keep split-off parts out of the dialogue. The price is high also. The transformation of repetition compulsion and the restoration of freedom of choice take place through the transference and the dialogue, but unconscious guilt and shame in the therapist surrounding the same impulses as those present in the patient may seriously disturb the quality of the dialogue and counteract integration.
My first clinical illustration at the beginning of this review may not seem relevant to the topic of vertical split. Yet it is. Perhaps nowhere is collusion so pervasive as when aspects of the grandiose self are involved. Grandiosity is shameful for therapists and patients alike. In order to help one's patients, one needs courage to enter this difficult terrain where troubled parts of oneself still remain. Goldberg's book is a very good companion.