Review of PATHOLOGICAL IDENTIFICATION, Steven A. Foreman, MD

Posted March 27, 2018 

Review of PATHOLOGICAL IDENTIFICATION, by Steven A. Foreman, MD Psychoanalytic Psychology 2018, Vol. 35, No. 1, 15–30

Reviewed by Peter Schumacher, MFT

Joseph Weiss developed and wrote about his ideas for many years before they coalesced around a key psychoanalytic understanding that eventually gave birth to what we know today as Control Mastery Theory.  In an early paper (Weiss, J. 1968), he discussed a comparison between two competing contemporary models of psychoanalytic process.  The two models, “progressive stripping away” and “progressive integration,” were each used to provide an overall perspective on the changes that occur in analysis.  The first and more popular model, stripping away — or “successive uncovering” it was sometimes called — was akin to the analogy of peeling an onion; peeling away successive layers of mental life, and analyzing each new layer as it appeared.  At the time, this was widely considered a helpful orienting model of psychotherapeutic process.  It allowed the clinician to have a working analogy, and a perspective from which important questions could be examined and resistances could be addressed as they successively emerged.  This led eventually to the final goal of the analysis, the core of the onion, as it were, being interpretation of fantasy that was related to early primary process.  This analogical model had its limitations, however, in that it could take years to know if actual patient progress were being made in any given analysis because there was no specific indicator of forward movement.  Not to mention that the human psyche is complex, and doesn’t easily lend itself to being compared with an onion.

The second model, progressive integration, builds on the first but with a twist.  Instead of working with resistances and penetrating deeper and deeper into layers of warded-off material, the clinician works with emerging material to allow for an integration of warded-off contents, resulting in “progressive acquisition of new capacities.”

Joseph Weiss saw the benefits of the integration model as a description of what he was to later call “mastery.”  As a person integrates warded-off contents, over time she or he becomes more able to consciously regulate attitudes, feelings, and behaviors that previously were unavailable or unconsciously expressed as painful repetitions.

Both models were about bringing forth unconscious material, but Weiss pointed out that the model of progressive integration added an important new feature, leading to a significant contribution to the practice of psychotherapy.  Weiss saw that the integration model allowed for the formulation of a practical theoretical construct of progress in therapy.  Patient progress was described in the paper as a “change in the transference and recovery of new memories.”  Progress in therapy can now be observed immediately following an intervention or interpretation.  This paper was a major development in psychoanalytic and psychotherapeutic thinking, and, as noted earlier, was the foundation of Control Mastery Theory.

Steven Foreman makes a similar step forward with his paper on Pathological Identification.  Using the concept described by Joe Weiss to understand the problem of repetition or reenactment of parental pathology, Foreman points to an aspect of attachment behavior that gives identification new meaning within early attachment patterns, which has important implications for psychotherapeutic technique.

Using clinical examples to illustrate what the process looks like, Steven Foreman clearly and articulately lays out the relationship between early childhood trauma and adult repetition of problematic behavior.  He also distinguishes the more “destructive” pathological identification from the “normal” psychological process of identification with a parent figure.

Joe Weiss used Neiderland’s term “survivor guilt” to explain painful pathological identifications, where the child would feel something akin to survivor guilt if he or she would surpass the parents in areas where the parents were deficient.  According to Weiss, in order to avoid feeling guilt about outdoing parents, children imitate problematic parental behaviors, feelings and attitudes, and in this way hold themselves back, thus protecting the parents from shame and reinforcing attachment.  Weiss used the term “unconscious guilt” to describe this phenomenon.  Foreman, in noting that the guilt Weiss referred to was potential guilt, recognized that guilt was not the primary emotional process driving the dynamic in early attachment.

Steven Foreman saw that the primary emotional driver of attachment was not guilt, or the fear of guilt, but the powerful motivation to be “empathic, caring and protective” toward parents and parent figures. When children imitate problematic parental behaviors and attitudes, they may fear the repercussions of doing better than the parents, but primarily children want to protect the parents from their own critical feelings about the parents.

This change in emphasis, from avoidance of guilt to feelings of protection for the parents, presents us with a new and practical theoretical construct that has important implications for treatment.  Foreman, by following patterns in case material like Weiss much earlier, realized that patients do not relate as easily to interpretations focused on avoiding guilt as they do to interpretations and interventions focused on protective feelings for their parents.

This also intuitively makes sense.  Interpreting avoidance of guilt feels more accusatory than interpreting protective feelings for the parents.  This shift gives the clinician both a clearer picture of the etiology of psychopathology and a very useful perspective from which to structure helpful interpretations and interventions.  Additionally, Steven Foreman outlines specific strategies for utilizing technique based on this model of psychopathology in four sequential steps.  This paper is a major advance in both developmental theory and theory of psychopathology.

References:

Niederland, W. G. (1981). The survivor syndrome: Further observations and dimensions. Journal of the American Psychoanalytic Association, 29, 413–425.

Weiss, J. (1968). Stripping Away and Integration: Two Perspectives on the Therapeutic Process.  Unpublished paper.  San Francisco Psychotherapy Research Group archive.