Modern Psychoanalysis


Tuesday, June 10, 2008

Clinical Techniques: #4 - Joining

Clinical Techniques: #4 - Joining
According to Dr. Hyman Spotnitz:
“Many communications that have a maturational effect reflect the old adage: If you can’t lick ‘em, join ‘em… The term ‘joining’ denotes the use of one or more ego-modifying techniques to help the patient move out of a repetitive pattern.”
(1985, p. 253).
This statement gives us some indication of both what “joining” is, and why we might use it; i.e., that joining avoids attacking the patient’s defensive mechanisms, while simultaneously helping the patient to engage in progressive communication with the therapist.

Dr. Benjamin D. Margolis says that:
“The ultimate purpose, in every instance, is to help the patient mobilize and liberate the negative (as well as the positive) feelings he has long kept submerged. The analyst accomplishes this by first joining the patient’s resistance and supporting and reinforcing his uncooperative attitudes.”
(1983, pp. 219-220).

Reinforcing uncooperative attitudes!?! – statements such as these give the reader some idea of how uniquely modern analysis works, as well as why it often works when other methods fail.

Dr. Spotnitz amplifies the intent even further; saying that

“The term ‘joining techniques’ is loosely applied to a number of basically similar interventions… By and large, all of these interventions communicate the same message to the patient: I am like you.” (1985, p. 263).
Thus, patients who may have spent a lifetime being criticized by well-meaning others, commonly find that modern psychoanalysis provides them with an experience where they can feel connected in a way they have rarely experienced otherwise in their lives.

A theoretical way of looking at the same thing is to say that “By functioning as an ego-syntonic object, the analyst facilitates the development of transference on a narcissistic basis as well as its eventual transformation into object transference.” (Spotnitz, 1976a, p. 142).

The various joining techniques used by modern analysts are sometimes further roughly divided into “ego-syntonic” and “ego-dystonic” joining.

One of the better known ego-dystonic joins used by Dr. Spotnitz related that when a
“… young man, trying to force the analyst to talk to him, shouted that he would 'get off the couch and bash your head in.’ The analyst responded ‘I’ll bash yours in before you can get off the couch.’”
(Spotnitz, 1985, p. 265).

Ego-dystonic joins such as this appear counterintuitive, but frequently help patient’s verbalize negative affects and feel more comfortable in the treatment relationship.

Benjamin Margolis has given us some wonderful examples of different types of ego-syntonic joining:

“P: I slept poorly last might and feel tired today.
A: You look tired.
P: I feel miserable.
A: You’re entitled to feel miserable.
P: (after a harrowing review of his life’s history) I haven’t had
much in the way of pleasure.
A: Life has been one misery after another.”

(1983, p. 214).

None of these techniques are applied in a cavalier manner. As with any of the other modern analytic techniques we have discussed, therapists would do well to keep in mind Dr. Spotnitz’s caution, (1976b, p. 146), that

“Technical proficiency is of little avail if it does not help the analyst to develop in himself the kind of feelings that will catalyze the release of his own emotional energy in language.”
Margolis echoes Spotnitz by saying:
“Joining is a powerful technique for resolving narcissistic resistance in psychoanalytic therapy. Its very power, however, calls for prudence in determining when and how to apply it… Generally speaking, technical skills such as joining come into perspective only as they further the objectives of a comprehensive therapeutic design… The joining technique, presented as it is, has no intrinsic significance.”
(1983, p. 211, emphasis original).

The significance comes from a trained therapist utilizing the technique when necessary and when this is something the patient needs. As Margolis says,

“If the analyst is in resonance with the patient, his joining and mirroring remarks, while addressed to the literal resistance message, will simultaneously engage the unconscious emotional contents sheltering behind it.”
(1983, p. 213).

Clinical techniques such as joining have greatly increased the ability of modern psychoanalysts to deal with difficulties in patients which were previously thought to be irremediable.

Though years of modern analytic training may be necessary to obtain even rudimentary proficiency in these techniques, they help modern therapists provide effective treatment to those who were formerly believed to be beyond help.

Margolis, B. (1983). Joining, Mirroring, Psychological Reflection: Terminology, Definitions, Theoretical Considerations. (Modern Psychoanalysis, Vol. 11, No. 1 & 2, 1983; as reprinted in Modern Psychoanalysis, Papers of Benjamin Margolis).




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