A Primer of Clinical Interpretation: Classic and Post-Classic Approaches (Book Review)

Author:  Rubovits-Seitz, Philip F.D.
Publisher:  Jason Aronson, 2002
Reviewed By:  Edwin Fancher, Summer 2003, pp. 71-72

Philip F.D. Rubovits-Seitz is a Washington DC psychoanalyst who has been concerned about the role and nature of interpretations since 1966 when he was part of a research team studying the variability of blind interpretations. He writes how he and his colleagues “were never able to achieve satisfactory consensus on the blind interpretation of the same case material” (p. x). One of the principles of interpretation he wishes to emphasize in this book is “Basing interpretations on clinical data rather than on clinical theories, so that interpretations are specific to the individual patient” (p. xi). He is particularly concerned that the therapist interprets tentatively rather than authoritatively.

This book might best be seen as two books in one. Part I of the book is a pretty good primer on interpretation and other basic techniques of psychoanalytic psychotherapy, most suitable for the beginning therapist. Part II might be considered a primer on the extensions and revisions of classical theory by several contemporary psychoanalysts, and would be of interest primarily to trained psychoanalysts or advanced psychotherapists. All text in both parts is presented in a question and answer format where the questions focus on fundamental issues about interpretation and related matters. Questions are answered directly, followed by a brief clinical vignette illustrating the issue in the text. Each chapter ends with a list of references appropriate for that chapter. And, in Part I each chapter ends with a recapitulation.

Part I, “The Classical Approach to Interpretation,” presents Freud’s views on technique, revised somewhat by the author, and supplemented by views of other analysts. The chapters in Part I cover the definition of interpretation, data observation and processing, reconstruction, how to interpret to the patient, how to detect and correct errors in interpretation, and the development of self-interpretation. By and large his approach derives from Freud’s works on technique, almost all of which were written when the topographic theory provided the foundation for psychoanalysis. Rubovits-Seitz considers psychopathology primarily in terms of the topographic theory. For instance, he proposes that “.... the repressed can ‘return’ in two principle ways: (1) massive breakdown of repression with extensive ‘herniation’ of the unconscious into the preconscious and consciousness, which produces psychosis and (2) a ‘slow leak’ of repressed material from the unconscious” (p.12)—which may cause normal phenomena, such as dreams, slips of the tongue, sublimations in art, etc. Or, he continues, “Other more extensive leaks may produce psychoneurotic symptoms, personality disorders, somatization reactions and other effects” (p.12). He illustrated this principle by presenting a case showing that hypnosis caused a substitution of symptoms. He then reported that this patient was subsequently helped by dynamic psychotherapy, which led to “an abreaction of memories” (p. 14) as a curative factor, rather than by interpretation. To be sure, the author defines psychopathology and interpretation primarily in terms of the topographic theory, and tends to neglect the contributions of Ego psychology.

In his chapter “Collection and Observation of Clinical Data,” he points out that our clinical data consists of what the patient says to us. He provides a reasonable review of the problems of using free association and “freely hovering attention” in the listening process (p.29). He also does a good job explaining the importance of listening for context, contiguity, sequences and patterns in the patient’s material. In his chapter “Construction and Reconstruction” he uses both Freud and Arlow to good effect. He frankly acknowledges that the initial phase of interpretation is guessing, and provides an excellent description of the various phases interpretation goes through as it becomes more accurate for the specific patient. He is very good on the process of listening and formulating the interpretation. This chapter is followed by another excellent one called “Checking the Correctness of Interpretations.” Rubovits-Seitz disputes Freud’s idea that interpretation is easy. It is always difficult and tentative and he recommends, “ ‘Damage control,’ that is systematic use of error-detecting, error-correcting and justifying procedures, needs to become an accepted and regular part of the interpretive process” (p. 69). These two chapters would be particularly helpful to a beginning therapist.

In Chapter 6, “Communicating Interpretation to the Patient” the author tries to introduce his reader to more contemporary changes in technique. He notes that since Freud there has been greater attention on countertransference, more emphasis on the here-and-now, less belief in the therapist’s authority, a de-emphasis on intrapsychic phenomena, a greater focus on two-person psychology, and an increase in self-disclosure. He mentions very briefly Thomas French, Loewenstein, Kernberg, and Jacobs. Then, for some unclear reason, he introduces a discussion of the theories of Mitchell and Greenberg and the dialectical constructive approach of Irwin Z. Hoffman, which he treats with greater detail in separate chapters in Section II of the book. The last chapter in Section I is called “Development of Self-Interpretive Competence.” He makes an excellent case for helping the patient to make his own interpretations; he notes how “…it seems likely that giving the patient ample opportunity to use and to practice his or her own self-interpretive capacity during the therapeutic process may promote more robust development of self-interpretive competence” (p.126).

Part II of the book seems like an extension of Chapter 6, in that it consists of seven chapters on the clinical theories of Kohut, Hoffman, Schafer, Spence, the Intersubjective Approach, the Radical Relational Approach, and finally, Pluralistic Approaches. The chapter on Kohut quotes Goldberg as describing “…three main branches within Self Psychology that compete for influence in the field: the traditional, intersubjective and relational groups” (p.144). He notes approvingly that Goldberg believes that “self psychology is working itself free from an absolute allegiance to Kohut” (p.141). He quotes Goldberg that “a correct or ideal emotional position on the part of the analyst is insufficient by itself: interpretation must carry the brunt of the analytic process” (p.141). Is this rebellion within the Self psychology camp?

In his chapter on Hoffman, he discusses the belief that the patient and analyst jointly create all clinical data. This is not too different from Schafer’s point that all interpretations are, in the end, co-authored. However, he does not mention Schafer’s later attachment to the Modern Kleinians of London. He reports Spence’s radical critique “that clinical interpretations are based less on fact than on fiction, and that the therapist’s interpretations are merely narratives that have no evidential value, but only rhetorical appeal” (p.169). In spite of such harsh judgments, Rubovitz-Seitz feels that Spence’s “…ways of dealing with clinical material suggests that his aim is not to tear down psychoanalysis and clinical interpretation but to improve them” (p.180). Rubovits-Seitz seems to regard the Stolorow school and the Miller—Greenberg group as spin-offs from Self psychology. He refers to a late Greenberg paper (2001) as pointing out many of the limitations of the Radical Relational Approach, which he seems less enthusiastic about.

The last chapter, “Pluralistic Approaches,” clearly reflects the author’s personal point of view. He draws on Busch, Jacobs, Meissner, Mitchell, Aron, and others to try to find a common ground for clinical theory. He did not convince me that he, or anyone else, could integrate these diverse and often contradictory contributions successfully.

Part I of this book could be an excellent text for beginning therapists, although I regret that the author did not include more Ego psychology in his exposition. There is hardly a mention of the structural theory, and only a few passing references to any leading Ego psychologists. Part II is, in my view, inappropriate for beginning therapists; these chapters would likely be totally confusing. In my experience, it is hard enough for a new therapist to master one approach, and presenting several more at the same time leads to chaos. However, Part II may be of interest to seasoned clinicians or analysts interested in a brief summary and thoughtful critique of the theories of some of the leading contemporary analysts writing in our field today.

Greenberg, J. (2001). The analyst’s participation: A new look. Journal of the American Psychoanalytic Association, 49, 457-491.

Edwin Fancher is a training and supervising analyst and faculty member of the New York Freudian Society and founding president of the New York School for Psychoanalytic Psychotherapy and Psychoanalysis.

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