THE P-H-E PERSEPCTIVE IN THE CONSULTING ROOM

OCT 17, 2009

張凱理醫師

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題綱: 對兩個命題的說明

• 1. 個別動力心理治療的兩大基石為 客體關係理論 和自體理論
• 2. 從人文學的傳統迴溯心理治療 這個迴溯將體現於現象詮釋存在觀點

THE TWO DIMENSIONS OF PSYCHOTHERAPY

• object relations self

issues development

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• no way out                             no way to go 
• complexes to work through  leverage for

change 

• through the maze             exit of the maze
• reverie as possible  appreciation with

(therapist) blessing (therapist)

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History of Psychoanalysis

1. Id psychology

2. Ego Psychology

3. Object Relations Theories

. Kleinians

. Middle School (The Independent School)

. Interpersonal Psychoanalysis

. Attachment Theory

4. Self Psychology

. Intersubjectivity Theory

5. Lacanians

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That Area …

• The phenomena of borderline and narcissism
• The paranoid-schizoid position (Melanie Klein)
• Borderline Personality Organization (BPO) (Otto Kernberg)
• Basic Fault (Michael Balint)
• The insecure attachment (John Bowlby)
• Poor differentiation of the self (Murray Bowen)
• Self Disorders (Heinz Kohut)
• The conditions for one to be one cannot be taken for granted.

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Classification of developmental psychopathology

1. Adjustment disorder with/without underlying disordered self
2. Neurosis with underlying enfeebled (or more seriously disordered) self
3. Self disorders proper

NPD (narcissistic personality disorder)

NBDs (narcissistic behavioral disorders)

(e.g., drug abuse, eating disorders [especially

bulimia], paraphilias, impulse control disorders,

crimes, etc)

Borderline state

BPD (borderline personality disorder)

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PSYCHOANALYSIS VS. DYNAMIC PSYCHOTHERAPY

• I often think of my clinical work in terms of doing as much psychoanalysis as possible in a context where I do as much psychotherapy as necessary --- the latter being precisely what makes it possible to pursue the former.

(Fred Pine, Diversity and Direction in

Psychoanalytic Technique, 2003, p3)

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PSYCHOANALYSIS VS. DYNAMIC PSYCHOTHERAPY

• It's more difficult to practice intensive psychotherapy than it is to practice psychoanalysis, because the therapist doing intensive psychotherapy often must shift techniques from session to session depending on the state of the patient at the time, whereas psychoanalysis assumes a relatively high level of ego functioning and more stability on the part of the patient.

(Chessick, 1996)

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Dynamic Psychotherapy vs. Existential Therapy

• I often think of my clinical work in terms of doing as much existential therapy as possible in a context where I do as much dynamic psychotherapy as necessary --- the latter being precisely what makes it possible to pursue the former.

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P-H-E: THE ESSENCE OF PSYCHOTHERAPY

• Phenomenological way
• Hermeneutic experience
• Existential concern

WHY P-H-E?

• ROAD LESS TRAVELLED …
• BEING-AT-HOME-NESS (人文的原鄉)
• 人的質地
• “HOMO SUM; NIHIL HUMANI ME ALIENUM PUTO.” (“I AM A MAN; NOTHING HUMAN IS ALIEN TO ME.”) TERENCE, ROMAN PLAYWRIGHT

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WHY P-H-E?

• My world is one of personal meanings --- and the underlying value of phenomenological psychology is to empower its practitioners and readers to re-assert the human perspective.

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(Phenomenology and Psychological Science: Historical

and Philosophical Perspectives, ed. by Peter Ashworth,

Man Cheung Chung, Springer, 2006, p. 205)

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Psychotherapy as a Human Science

• Truth, Method, and the Limits of Reason (Descartes, Pascal)
• Reason, the Unconscious, and History (Kant, Hegel, and Marx)
• Angst, Authenticity, and Ressentiment (Kierkegaard, Nietzshce)
• Psychology as a Human Science (Dilthey, Husserl)
• Psychology of the Unconscious (Freud, Jung)
• Phenomenology and Human Experience (Scheler, Jaspers, Heidegger)
• Modes of Relatedness (Buber, Binswanger, Boss)
• Recognition and the Limits of Reciprocity (Sartre, Lacan, Laing)
• Psychoanalysis and Intersubjectivity (Sullivan, Fromm, Merleau-Ponty, Benjamin, Stolorow)

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(Psychotherapy as a Human Science, by Daniel Burston &

Roger Frie, Duquesne University Press, 2006)

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What Freud Said about Philosophy (1921)

• The decisive reason for the rejection of Putnam’s proposals was the doubt as to which of the countless philosophical systems should be accepted, since they all seemed to rest on an equally insecure basis, and since everything had up till then been sacrificed for the sake of the relative certainty of the results of psychoanalysis. It seemed more prudent to wait, and to discover whether a particular attitude towards life might be forced upon us with all the weight of necessity by analytic investigation itself.

(Sigmund Freud, Jan 1921, in the Preface of “Addresses on Psychoanalysis”, by J.J. Putnam, 1921, p. iv)

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A HUNDRED YEARS OF PHILOSOPHICAL ANTHROPOLOGY

• … Dilthey was searching for a reale Psychologie that could serve as the foundation for the human studies (Geisteswissenschaften) --- a radically new psychology … a “descriptive and analytic psychology,” as opposed to the “explanatory psychology” of the physicists … Dilthey failed, and indeed, one may trace the whole history of phenomenology as a series of glorious failures … (David Holbrook, 1987, p. 60)

PHENOMENOLOGICAL METHOD

• The phenomenological method:
• 1. the rule of “epoche”
• 2. the rule of description
• 3. the rule of horizontalization

(the equalization rule)

(Ernesto Spinelli, 2005, pp. 20-23)

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PHENOMENOLOGICAL RESEARCH

• FORMULATION OF THE RESEARCH QUESTION
• INTUITIVE CONTACT WITH THE PHENOMENON
• REFLECTIVE ANALYSIS OF QUALITATIVE DATA
• PSYCHOLOGICAL DESCRIPTION

(Churchill & Wertz, 2001, pp. 251-254)

PHENOMENOLOGICAL RESEARCH

• 1. Philosophical perspectives and epoche
• 2. Research question and lived experiences
• 3. Criterion-based sampling
• 4. Phenomenological data analysis
• 5. Essential, invariant structure (or essence) of the lived experience

(Summarizing Creswell, 1998, see Heppner et al., 2008, pp. 270-271)

QUALITATIVE RESEARCH

• 1. NARRATIVE RESEARCH
• 2. PHENOMENOLOGY
• 3. GROUNDED THEORY
• 4. ETHNOGRAPHY
• 5. CASE STUDY

(Qualitative Inquiry & Research Design: Choosing Among Five

Approaches, 2nd ed., by John Creswell, Sage, 2007)

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QUALITATIVE RESEARCH

• … psychology is not merely the science of behavior or of experience in and of itself but rather a study of the meaning(s) of experience and behavior for the individual person. (Wertz 2001, p. 242)

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做為人文精神重建基礎的詮釋學

• Philosophical Hermeneutics as a Hermeneutics of the Humanities
• Philosophical Hermeneutics as a Hermeneutics of Experience
• Philosophical Hermeneutics and the Voice of the Other

(Hermeneutics and the Voice of the Other: Re-reading

Gadamer’s Philosophical Hermeneutics, by James

Risser, SUNY, 1997, pp. 4-17)

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Philosophical Hermeneutics and the Voice of the Other

• … the concern of PH is with the problematic of understanding … understanding is only found in the living word, in the word of memory … PH is a hermeneutics of the voice … H is letting that which is far and alienated (噤啞的他者) speak again “not only in a new voice but in a clearer voice” … The dialogical element of hermeneutic understanding means that what is brought to speech again is the voice the other …

Philosophical Hermeneutics and the Voice of the Other

• What is at stake in understanding is the otherness of the text (他者的聲音的文本的他者性) and its ability to assert its truth against one’s own fore-meanings. … in the analysis of hermeneutic experience near the end of part 2 of TM (Truth and Method), Gadamer shows how hermeneutic experience is comparable to the experience of the Thou in the I-Thou relation. … perhaps as a result of his contact with deconstruction but certainly as a result his contact with the poetry of Paul Celan, the voice the other is not to be regarded as a voice to be assimilated. …

Philosophical Hermeneutics and the Voice of the Other

• Understanding is not a mere assimilation into identity where what is foreign is made near again as a return to identity in a subject. … In hermeneutic conversation the performance of meaning necessarily demands that one be exposed to the rejoinder of the other. It is to think with the other and to come back to oneself as if to another.

Philosophical Hermeneutics and the Voice of the Other

• The poetic word holds within itself a breathless stillness … For Gadamer as a reader of Celan’s poetry, the task of understanding is not to make poetry transparent, but to enter into that space of transparency and non-transparency. … In the end a PH is about self-understanding; but this, Gadamer insists, has little to do with a philosophy of subjectivity. Rather, it has to do with our being at home in the world that we are awakened to in the voice of the other.

Who Am I and Who Are You?

• In his later volumes of poetry, Paul Celan increasingly moved toward the breathless stillness of muted silence in words which have become cryptic. … I will examine a sequence of poems from the book Breath-turn (Breath-crystal 1965) … Each of the poems has its place in a sequence, and read within this context, each poem achieves a certain measure of precision --- but the entire sequence of these poems is hermetically encoded. What are they about? Who is speaking?

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Who Am I and Who Are You?

• Even so, every poem in this sequence is a configuration of unambiguous precision; and while they are not transparent, nor articulated with direct clarity, neither are they veiled, or capable of being interpreted arbitrarily. This is the experience of reading which awaits the patient reader. The reader who is interested in understanding and decoding hermetic lyrics must clearly not be hurried. Such a reader need not be scholarly, or especially learned. He or she must simply try to keep listening.

(Gadamer on Celan: “Who Am I and Who Are You?” and Other Essays, by Hans-Georg Gadamer, SUNY, 1997, p. 67)

THE HERMENEUTICS OF MEDICINE AND THE PHENOMENOLOGY OF HEALTH: STEPS TOWARDS A PHILOSOPHY OF MEDICAL PRACTICE

• Clinical medicine is not a theory, not even an applied theory, but a practice. This practice can best be understood as an interpretive meeting between health-care personnel and patient with the aim of healing the ill person seeking help. Hermeneutics will in this work be used to further explicate what is understood by ‘an interpretive meeting’, and phenomenology will be put o work to better understand the meaning of ‘health’ and ‘illness’. (Svenaeus, 2000, p.2)

�����THE HERMENEUTICS OF MEDICINE AND THE PHENOMENOLOGY OF HEALTH: STEPS TOWARDS A PHILOSOPHY OF MEDICAL PRACTICE

• 2.7 Health as homelike being-in-the-world
• 3.2 Hermeneutics --- the choice of Gadamer
• The kind of hermeneutics which I will try to show is basic to clinical practice is the very same kind that Heidegger developed as the existential of understanding being-in-the-world in Sein und Zeit. … Hermeneutics is here an ontological and not a methodological concept; that is, hermeneutics is not taken as a method, but as a basic aspect of life. … To be --- to exist --- means to understand. (ibid., pp. 131-132)

THE HERMENEUTICS OF MEDICINE AND THE PHENOMENOLOGY OF HEALTH: STEPS TOWARDS A PHILOSOPHY OF MEDICAL PRACTICE

• The emphasis on the world of the other in Gadamer’s hermeneutics is important, because it brings out an aspect of being-in-the-world in a new way, namely, the alienness of the world. (ibid., p. 133)

THE HERMENEUTICS OF MEDICINE AND THE PHENOMENOLOGY OF HEALTH: STEPS TOWARDS A PHILOSOPHY OF MEDICAL PRACTICE

• 3.3 Medicine and Hermeneutics
• The literature can be organized into three groups: (1) hermeneutics as an interpretive guide to different texts written and read in the clinic (2) hermeneutics as being of significance to medical ethics (3) hermeneutics as a model of the clinical activity itself. (ibid., p. 135)

EXISTENTIALISM

• I came to existentialism on my knees, after a youthful divorce and in the cold grip of a withering depression. As a professor of philosophy, I realize that it is not fashionable and, philosophically speaking, almost vulgar to begin an anthology with a confession, but existentialism is a much more personal form of philosophizing than any other. In fact, some of the existential philosophers whom you will shake hands with in this book insist on working from the first-person perspective.

(Basic Writings of Existentialism, ed. by Gordon

Marino, The Modern Library, 2004, p. ix)

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為什麼要講存在?

• 在生命轉彎處 崩塌時 日復一日 無以為繼之際 面對做一個人的腳跟下大事

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Daseinsanalysis: Foundations for an Existential Therapy

• Ludwig Binswanger (1881-1966) founded the Daseinsanalytic movement in the early 1930s … an approach he termed “Daseinsanalyse” or “phenomenological anthropology”.
• Medard Boss (1903-1990), however, was to become the pivotal figure in the development of Daseinsanalysis.

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Zollikon Seminars (1987, 2001)

• (When Medard Boss was recruited to the Swiss Army mountain troop in WWII) For the first time in my life, I was occasionally gripped by boredom. In the midst of it, what we call ‘time’ became problematic for me. I began to think specifically about this ‘thing’. … By chance, I came across a newspaper item about Heidegger’s book Being and Time.

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Zollikon Seminars

• I plunged into it, but I discovered that I understood almost none of its content. The book opened up question after question which I had never encountered before in my entirely scientifically oriented education. For the most part, these questions were answered in reference to new questions. Disappointed, I laid the book aside only half-read, but strangely it gave me no rest.

Zollikon Seminars

• Boss wrote to Heidegger finally in 1947 and asked for help in (reflective) thinking. Boss was very surprised when an answer arrived by return mail. In the ensuing years, there were 256 exchange of letters by Heidegger to Boss by the time of Heidegger’s death.

Zollikon Seminars

• The series of seminars began on Sep 8, 1959, at “Burgholzli” at first. … from the second time the seminar was moved to my home in Zollikon. The seminars went on till 1970. From then on, I asked for his intellectual help only by mail or during my visit to his home in Freiburg.

Medard Boss, 1987

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Heidegger reading Freud

• Even before our first encounter, I had heard of Heidegger’s abysmal aversion to all modern psychology. To me, too, he made no secret of his opposition to it. His repugnance mounted considerably after I had induced him with much guile and cunning to delve directly for the first time into Freud’s own writings.

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Heidegger reading Freud

• During the perusal of the theoretical, ‘metapsychological’ works, Heidegger never ceased shaking his head. He simply did not want to have to accept that such a highly intelligent and gifted man as Freud could produce such artificial, inhuman, indeed absurd and purely fictitious construction about Homo sapiens. This reading made him literally feel ill.

(Medard Boss, 1988)

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Why Heidegger felt ill?

• According to Heidegger, Freud was the epitome of a great contemporary scientific mind uncritically adopting and subsequently becoming entrapped by the tacit ontological commitments of his philosophical heritage.

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Because …

• “Psychoanalysis must accept the scientific Weltanschauung … the intellect and the mind are objects for scientific research in exactly the same way as non-human things. … Our best hope for the future is that intellect --- the scientific spirit, reason --- may in process of time establish a dictatorship in the mental life of man.”

(Freud, SE XXII, p.171)

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Zollikon Seminars

• In this new and alternative view, human existence in its unique way, like everything else in our world, no longer appears as something present as an object within a pregiven world space. Rather human existence can be viewed as being, which cannot be objectified and which consists of an openness to the world and of the capacity to perceive what it encounters in that world. Through this openness, human existence itself, as well as any other given facts of our world, can come to their presence and unfolding.

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Zollikon Seminars

• The proper task of human Dasein is the event of letting-be what emerges into the openness of being. Human existence is necessary for this event, which constitutes its proper and most profound meaning. Thus, it also becomes clear that this meditative, alternative, and new way of thinking may also disclose meaning and purpose to the art of healing.

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Zollikon Seminars

• Heidegger would not have devoted as much time and energy to instructing medical doctors as he did in the Zollikon Seminars had he not thought his new and alternative thinking --- meditative thinking --- was of essential benefit to all medical therapies. From then on, they would understand themselves as individuals who are called upon to serve all beings including patients, who in their openness to the world encounter the therapist as a place for self-disclosure.

Medard Boss

Spring, 1990

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Daseinsanalysis

• Just as the psychologically healthy individual is a shepherd to the Beingness of the world, so the effective therapist is a shepherd to the Being of the client, which allows all of her world-disclosing possibilities to come to light.

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為什麼要講存在治療?

• Existential philosophers have depicted the existence in many different ways, but what is common to each of their descriptions is a radical challenge to many of our contemporary assumptions about what it means to be human. … together they create a radically new, and radically humanizing, image of what it means to exist. What better foundations, then, on which to construct the most human of professional practices: counseling and psychotherapy?

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