Hans Loewald, “On the Therapeutic Action of Psycho-Analysis” (1960) (IX)

The core of Loewald’s account, towards which his reflections on drive and early development have led, is now in view. For he is now able to elaborate a homology between (a) the infant-with-mother, and (b) the patient-with-analyst — and in considerable detail. In doing so, Loewald redeems a promise intimated in the piece’s title and explicit in its opening sections. For he still owes the reader an answer to the question of “therapeutic action”: what is structural change? — what does it look like, involve, and what are its enabling conditions?

In fact, “homology” is probably too weak a term to use in this context. The patient in analysis is something more than “akin” to the infant in its environmental situation, though it certainly is that. The relation is more profound than a homology because — as Loewald indicated in the introductory comments — the patient just is the infant, whose thwarted, stalled, or warped development is “reactivated” in an analysis, albeit at a “higher level.” The two situations look so similar, in other words, because the “essentials” of both personality and personality-change remain the same throughout life. This premise, it seems, is necessary background for grasping the full implications of the next passage, which I will quote in its entirety:

"The patient, who comes to the analyst for help through increased self-understanding, is led to this self-understanding by the understanding he finds in the analyst. The analyst operates on various levels of understanding. Whether he verbalizes his understanding to the patient on the level of clarifications of conscious material, whether he indicates or reiterates his intent of understanding, restates the procedure to be followed, or whether he interprets unconscious, verbal or other, material, and especially if he interprets transference and resistance — the analyst structures and articulates, or works towards structuring and articulating, the material and the productions offered by the patient. If an interpretation of unconscious meaning is timely, the words by which this meaning is expressed are recognizable to the patient as expressions of what he experiences. They organize for him what was previously less organized and thus give him the ‘distance’ from himself which enables him to understand, to see, to put into words and to ‘handle' what was previously not visible, understandable, speakable, tangible. A higher stage of organization, of both himself and his environment, is thus reached, by way of the organizing understanding which the analyst provides. The analyst functions as a representative of a higher stage of organization and mediates this to the patient, in so far as the analyst’s understanding is attuned to what is, and the way in which it is, in need of organization.” (24)

Loewald’s choice of words, which can hardly be accidental, echoes and recapitulates the qualities of infant-mother interaction, as he’d previously described it. In short, the ideal analyst is assigned the same package of “functions” as the mother. Thus Loewald perceives the analyst “structuring and articulating,” “expressing,” “organizing,” “enabling,” and “handling” vis-à-vis the patient, in all the latter’s “productions.” And this analyst, “representative of a higher stage of organization,” and “attuned” to the patient, is accordingly also in a position to “mediate” whatever requires mediation. Once again, Loewald appears to trade on a number of the interconnected meanings of “mediation” — to convey the “dependence" of the patient on the analyst, who “shapes,” “develops,” “transmits,” and “reconciles” vis-à-vis the patient and the latter’s “need” of higher organization.

Now, the specific ways in which an analyst performs these mediating tasks — hence the identity of these tasks — will of course differ enormously from the mother’s activities. The latter, we found, are defined by their concretion — their “literal” quality. The infant is “seen, felt, smelled, heard, touched by the mother,” whose “bodily handling of and concern with the child, the manner in which the child is fed, touched, cleaned, the way it is looked at, talked to, called by name, recognized and re-recognized” (20) are all indispensable for development.

The analyst, by contrast, in ways suited to the patient’s relative psychological maturity, accomplishes analogous “mediations” principally through language. In fact, Loewald’s major innovation here arguably consists in re-describing the canon of traditional analytic technique in terms of this “mediating” function — a function shared, to reiterate, mutatis mutandis, with the mother in the infant’s first years of life. Again:

“Whether he verbalizes his understanding to the patient on the level of clarifications of conscious material, whether he indicates or reiterates his intent of understanding, restates the procedure to be followed, or whether he interprets unconscious, verbal or other, material, and especially if he interprets transference and resistance — the analyst structures and articulates, or works towards structuring and articulating, the material and the productions offered by the patient.”

And of course — to complete the homology — the analyst, too, occupies the position of a “higher stage of organization,” and this introduces that “differential” which conditions the possibility of psychological growth for the patient. What applied to the infant and mother earlier, then, applies equally to an analysis: “Without such a ‘differential’ between organism and environment no development takes place” (24).

At this point, a modern clinician familiar with psychoanalytic intellectual history since Loewald’s piece — familiar, indeed, with authors such a Sándor Ferenczi and Erich Fromm, whose writings preceded this piece by decades — may feel uneasy about the way Loewald frames analysis here. His guileless claim that the analyst embodies “a higher stage of organization” compared to the patient, a relation which in essence reproduces the situation in the nursery, surely constitutes an “infantilization” of the patient-position. Evidently Loewald’s view does nothing to upset, and everything to fortify, the traditional, inegalitarian, and potentially authoritarian hierarchy between a healthy, mature, and fundamentally sane analyst-expert, on the one hand, and a “sick” patient who is deficient along each of these axes, on the other. It may be useful, then, to examine this impression, to see whether or not such view can credibly be imputed to Loewald, or whether phrases such as “higher stage of organization” conceal a more complicated, and perhaps more politically benign, set of ideas.