Competing Theories of Interpretation: An Integrative Approach (Book Review)

Author:  Hooberman, Robert
Publisher:  Jason Aronson
Reviewed By:  Arthur S. Brickman, PhD, ABPP , Fall 2008, XXVIII, No. 4, pp. 62-64

In Robert Hooberman’s beautiful new book, Competing Theories of Interpretation: An Integrative Approach, Hooberman addresses the central action of psychoanalytic and psychodynamic work, the process of interpretation, which in Hooberman’s definition consists of “a verbal interaction between therapist and patient that provides an explanation for a feeling, thought, memory, or action” (emphasis in original). Hooberman cites the variety of theories and approaches available for formulating interpretations, and posits the need for a unifying structure within which to negotiate among the options available at any given point in time. He suggests that the patient provides the structure. It is in fact the patient’s character structure. To Hooberman, character structure is the North Star and organizing principle guiding interpretive work with patients. It is in his thinking, following Silverman (1986), “the essence of a person.”

One latent issue embedded in Hooberman’s discussion is the fertile tension between the two parts of the concept “character structure.” Hooberman devotes time to defining character, which he has called the individual’s “worldview,” emphasizing that it is a universal trait and hence not in itself an aspect of psychopathology. He has addressed these themes in an earlier book, Character Transformation through the Psychotherapeutic Relationship (2002). The term “structure,” however, also is one that is laden with connotations and meanings that often are misunderstood. Hooberman elsewhere (2002) posits that “people internalize in their totality representations of their families’ modus operandi,” and these internalizations are the “structures” in their personalities. He cites Shapiro (2000), who construes psychic structure as a scaffolding or source of stability within our personalities. Indeed, when we think of a physical structure, such as a bridge or a building or the Great Pyramid of Cheops, our minds tend to think of something fixed, rigid, and permanent. Character structure tends to be thought of in the same way, as something inert and relatively permanent, that the individual has developed as a scaffold or organizing principle for all the other elements of his or her personality.

A structure, however, in fact is a dynamic mass of countervailing forces, placed together in such a way as to ensure stability and functionality. Potentially competing forces—starting with force #1, gravity—must be managed so they work together. This is true for the Brooklyn Bridge, and it’s true for the individual’s character. Any structure, be it a bridge or a person’s character, under the force of sufficient catastrophic stress can be compromised to the point of vulnerability or collapse. When a bridge is built, engineers attempt to foresee the types of stressors most likely to assault the structure, and accommodate the structure accordingly. From a developmental perspective, individuals do something comparable in the early years of character development, adapting to the emotional demands of their surroundings just as a physical structure is adapted to the environmental demands of its location. The difference, of course, is that the structure that individuals are building is their own personality. Consequently, individuals sometimes come to believe that the resulting structure had little to do with the demands of those early stressors, that early environment. Their character or personality is presumed not to consist of or to include a serious of accommodations and adaptations, but rather to be a primordial configuration that always was “just there.” Through therapeutic work, however, the inner engineering of our characters can be exposed to the light, like an engineer inspecting a bridge to ensure its integrity. Where weaknesses in the structure are exposed, compensatory mechanisms can be established, which enable the individual to continue functioning in a healthier manner. This is where the work of interpretation comes in.

Hooberman tacitly recognizes and acknowledges this more dynamic concept of structure, and exploits it in his work with patients. He sees structure in its development as an adaptation, or a set of adaptations. By focusing on the countervailing forces constituting the individual’s character structure, rather than treating that structure as a monolith, Hooberman virtually explodes the obstacle that can frustrate therapists in working with difficult patients, as Hooberman addressed in a previous book (1998). Suddenly, these forces can be viewed from a variety of perspectives, in their inter-relationships, to see how one developed as a response to another, how they form an integrated whole, the ways in which they do or do not operate cohesively, and the areas most amenable to repair or most needing reinforcement. The personality becomes a dynamic whole. Now the therapist is working with the whole person, and not just the defensive shell.

The individual’s “representational world,” to use Hooberman’s phrase, now comes into focus not as a compendium of homunculi, but as a dynamic universe of forces, sometimes (inevitably) in conflict, expressive of the individual’s needs and desires. So when Hooberman writes, for example, “there is a constant give-and-take in development between an individual’s tendency to internalize the qualities of important others and the need to establish separateness and eventual independence,” he is opening a window into the way in which the inner structure is constantly in motion, just as your house constantly is expanding and contracting, or “breathing.” Personality dynamics are not ancillary to character structure; they are integral to it.

Hooberman’s conception of “central fantasy” is a core element of his approach to working with patients. As he seeks out the central themes and issues that most need to be addressed in treatment, invariably he discerns an imagined solution to unresolved frustrations and conflicts from childhood. The more this solution, or fantasy, is brought into focus, the clearer the work becomes, and the more guided it can be. One might say that the central fantasy is force #1, the “gravity” in the character structure. All other forces are arrayed in an attempt to accommodate that fantasy, for better or worse. The diagnostic formulation consists of understanding the complex array of forces—defenses, internalizations, compromise formations, and so on—that constitute the personality of the patient. Treatment consists of illuminating those forces, then reconfiguring the structure to accommodate those forces in more adaptive and healthy ways.

Hooberman opts for the conception of formulation, in contrast to diagnosis, as a more in-depth way of conceptualizing the whole person. As he presents his ideas in this area, he talks about the implicit and explicit, and about how the clinician arrives at an understanding of the “core issues” that are elaborated in the character structure. This approach focuses on a description of the ways that individuals work to avoid intrapsychic conflict—or, more precisely, to avoid the awareness of intrapsychic conflict—and how those strategies are played out in their daily lives and interpersonal relationships. In the elucidation of the central fantasy, the elaboration of the character structure developed to accommodate it, and the recognition of the way that the character is enacted in the patient’s life, the clinician constructs a roadmap for the effective use of interpretations, making use of now one theoretical model, now another, in the service of therapeutic growth and structural change.

Internalizations are construed in terms of family dynamics and re-enactments. One of the potential problems in the book is that the patients that Hooberman discusses seem to have a particularly pathological set of parents; virtually none of them seems to have had anything close to healthy parenting, and the parents are cited relentlessly as the source of the patients’ character pathology. One assumes, however, that Hooberman has chosen these specific patients and these clinical vignettes for their value in illuminating his approach, which in fact they do beautifully. He is quite lucid in tracing the legacies of the parents’ character on the personalities of their children, and in the way that those legacies are played out in the patient’s current life and in the transference.

The reader of the present book also may feel a bit lost searching for the “competing theories” of the title. Hooberman’s goal, however, is not to delve exhaustively into the complexities of drive theory, ego theory, relational theory, or other theories or sub-genres. Rather, his goal is to describe in applied practical terms how these various theories and approaches can be synthesized through the prism of character structure in the service of meaningful interpretation and effective treatment. This approach offers an organizing framework through which the analyst or therapist can adapt and utilize different theories and viewpoints while keeping the treatment fresh and alive.

The “competing theories” part of Hooberman’s approach perhaps comes most clearly into focus when he talks about ego and defense, and explains how he works with both conflict and deficit models depending on the patient’s presentation. It is fascinating to read Hooberman’s description of how he integrates counter-transference experience with his understanding of character structure in the service of formulating meaningful interpretations. The synthesis of his theoretical posture with a clear respect for technique, along with openness to his own internal world, allows him to engage some quite difficult patients with compassion and clarity. Again and again, he returns to his organizing framework of the “central fantasy” as a beacon to help pierce through the fog of the patient’s associations and behaviors. The reader sees him reaching across the void to connect with another individual in compelling fashion. Using such concepts as Ogden’s (1997) “reverie” and Loewald’s (1960) “new object,” Hooberman articulates with great transparency the ways that his approach helps his patients to form new perspectives on their emotions, their behaviors, and their lives.

A chapter is devoted to the particular technical and theoretical challenges of trauma, in the context of this approach. Hooberman discusses in specific terms the way that trauma undermines the patient’s efforts in the therapeutic task, and the ways that the therapist can ameliorate those effects in the service of treatment. The mentalizing process here takes on vivid and compelling immediacy. In detailing the internalizations likely to evolve as a result of early trauma, Hooberman elucidates the problems of negotiating the complex legacy of trauma, and presents strategies for keeping one’s bearings while remaining affectively engaged. He describes two characteristic reactions to early trauma, around which a personality constellation is likely to develop. These are chaos and despair. In the former, the victim/victimizer dynamic is re-enacted endlessly, including in the transference. In the latter, issues of control, distance, and the false self predominate. The author illustrates how he works with patients in both circumstances, helping them release themselves from the haunting grip of traumatic experience.

Hooberman’s book is replete with such vivid clinical examples. In these examples, he illustrates the ways that seemingly conflicting forces in the individual’s life and personality can be understood, brought to light, and interpreted in such a way as to make them amenable to change. These elegant vignettes succinctly illuminate Hooberman’s direct and compassionate style of working with a wide variety of patients. He addresses “the implicit,” the range of internalizations and ways of being that the individual develops out of awareness, apart from specific memories of traumata—which he addresses later—or other more conscious conflicts. Working with “the implicit” is central to Hooberman’s approach. It is quite refreshing to see how naturally he seems to evoke “the implicit” in various situations, and to make it explicit and hence more accessible to reflection and to direct therapeutic action.

This is an intensely personal book. Hooberman welcomes the reader not only into his consulting room, but into his mind. It is rare to have such a vivid sense of another therapist’s way of being with such a wide variety of patients. Often such descriptions feel highly technical at best, and suspiciously edited or false at worst. With Hooberman’s descriptions, no such disengagements are present. He is comfortable with his discomforts, at peace with his frustrations, candid about his reactions, and open about his inner world. One of the great assets of Hooberman’s approach is the flexibility it provides in addressing what the patient is presenting, and then connecting to other areas of the patient’s psyche. This slim volume is a rich source of challenging and stimulating ideas. It is likely to make psychoanalytically oriented clinicians reflect on their own approaches to formulation and interpretation, and even perhaps to re-examine some of the forces that guide their own work with patients.

References

Hooberman, R. (2002). Character transformation through the psychotherapeutic relationship. Northvale, NJ: Jason Aronson.
Hooberman, R., and Hooberman, B. (1998). Managing the difficult patient. Madison, CT: Psychosocial Press.
Loewald, H. (1960). On the therapeutic action of psychoanalysis. International Journal of Psychoanalysis 41 :16-33.
Ogden, T. H. (1997). Reverie and interpretation. Psychoanalytic Quarterly 66: 567-95.
Shapiro, D. (2002). Dynamics of character: Self regulation in psychopathology. New York: Basic Books.
Silverman, M. (1986). Identification in healthy and pathological character formation. International Journal of Psychoanalysis 67: 181-90.

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