Self-Creation: Psychoanalytic Therapy and the Art of the Possible (Book Review)

Author:  Summers, Frank
Publisher: Analytic Press, 2005
Reviewed By: David Anderegg, PhD, Vol. 26 (2), pp. 34-35

Is psychoanalytic psychology in the midst of a civil war? The "war" part of this metaphor seems apt, although "civil" may not work to describe the current ambience. Perfectly justifiable debates about theory seem to be devolving, with increasing frequency, into ad hominem attacks and charges and counter-charges of corruption, dishonesty, and just plain old lying (for example, Pizer, 2006). The things about which we argue seem clear enough: in the intersubjective matrix that seems a theoretical necessity given postmodern epistemology, how can we know what is "in" the patient? This is surely something worth arguing about, but the way in which we now argue is appalling.

In this poisonous atmosphere, Frank Summers’s book Self-Creation: Psychoanalytic Therapy and the Art of the Possible is as refreshing as a spring breeze. Summers has his theoretical adversaries, most notably Freud, and his arguments against classical metapsychology and technique are not completely justified (see below). He also has his heroes, most notably Winnicott and Loewald. But the book is not primarily polemical. It might seem relatively trivial to begin with tone: if the book has no substance, what good is polite discourse? Happily, Summers’s book is also substantial, scholarly, and original. But, from the beginning, the civilized voice welcomes the reader. The tone of the argument in this volume is remarkably respectful, serious, and yes, civil. Summers does not make a fuss about who he is against, but it is clear who he is for: our patients.

The book begins with a critique of the now-familiar problem of the relationship, in classical psychoanalytic theory, between insight and change. Like many contemporary analysts, Summers finds this relationship tenuous and theoretically weak, and unrescued by contemporary attempts to rescue it. Summers’s central thesis, in response to this theoretical quagmire, is almost purely Winnicottian in spirit. He criticizes all schools of contemporary analytic therapies for their over-emphasis on the therapist's activity and the therapist's contribution to psychic change. In Summers’s view, this makes the patient passive rather than active, "done to" rather than doing, even in contemporary relational theorizing. He takes us back to Winnicott's insistence on the "spontaneous gesture," the essential moment of creative action in potential space that makes for psychic change. It is in this gesture, this radically self-owned movement away from the past, that Summers finds the necessary antidote to analytic stalemate.

But what about that analytic stalemate? (Where is this articulate and kind man getting his referrals?) The heavy emphasis on frustration, failure and demoralization is a remarkable feature of Summers’s argument. He rightly castigates the classical Freudian conception of "working through" as theoretically and technically inadequate, and reminds us (over and over) that insight can only take our patients so far. But the over-emphasis on failure here is wrong: if all of our patients were so hamstrung, so unable to change despite the best of historical and here-and-now transference interpretations, we all would have given up long ago. It cannot be that every patient, as Summers seems to suggest, comes to a frustrating stalemate in which repeated interpretation turns to fruitless repetition at best and bullying at worst.

Indeed, this unnecessary bit of Freud-bashing is the weakest part of Summers’s book. After all, we might remember that it was not Freud who initiated the "widening scope" of psychoanalysis. He reminded us repeatedly that psychoanalysis, as he conceived it, was not for those whose ego weaknesses would not permit it. It seems a little unfair to castigate Freud for the inability of classical technique to cure those for whom it was never intended. Summers, following Winnicott, is not describing classical patients. He is describing patients who appear to deeply structured pre-Oedipal psychopathology. These seem to be people who have been subjected to such radical and intrusive projections from their primary objects that they do indeed seem to have had their futures "occluded" (to use a favorite term of Summers). But it cannot be true that all psychoanalytic patients are so bereft of the ability to use insight to move into new territory.

Summers’s insistence on the spontaneous gesture as originating, not in any past object relationship, but only in the core of the self is probably true in these extreme cases. There is no other choice. But there are theoretical alternatives that Summers does not consider. For example, a movement in the direction of a new, healthy or flexible way of living in the world can come about through the re-finding, in therapy, of a partial or fragmentary identification with a non-parental adult. (Anthony [1987], for example, describes something along these lines in his work on children who seem to survive extreme abuse and deprivation. The protective factor seems to be a positive relationship, however temporally fleeting, with a non-pathological adult.) Part of the occlusion Summers describes may not be true of all patients but may pertain more specifically to patients that do not have such latent or partial identifications to recover.

Summers moves on to cite another rationale for the theoretical necessity for a therapy focused on self-creation. This rationale is philosophical, and it has to do with the fact that "the future is inherent in psychological experience" (Summers, p. 31). Interpretations about past experience are never enough to explain the future, or to move us into it, according to Summers. Whether and how the past is projected onto the future is a topic for phenomenological philosophers, but their appearance in Summers’s book is neither complete enough to be useful nor necessary to his argument. The mystery of creativity--how the truly new thought comes into being out of the welter of past experiences, observations and fantasies—how anything original comes into the world at all—is still a mystery, but it is a mystery that does not need a solution here for Summers’s central argument to stand.

Summers does not, happily, throw out the interpretive baby with the bathwater. He insists upon the necessity of interpretation of the patient's past object relationships as lived out in the present and in the transference. Indeed, this stage of the work is a necessary prerequisite for the work of self-creation to begin. The movement back to a very early phase of the emergence of potential space is not defined as a regression, then, but as a kind of exhaustion: the patient lives out and understands, through relatively traditional transference interpretations, the brittleness and futility of existing object uses, and comes to a stalemate. For Summers, this stalemate is where self-creation begins.

Summers provides numerous clinical examples to demonstrate the difference between the therapist's interpretation of the past and the welcoming of the spontaneous gesture. For example, he describes the case of Anna, a socially adept and compliant woman whose apparent social fulfillment belied her internal sense of emptiness. After a period of calm and acquiescence in therapy, she erupted into rage. Summers states:

These outbursts constituted a free association indicating a previously buried desire to articulate her desires and interests and anger at their suppression. Viewing Anna's angry outburst as the emergence of an assertive way of being rather than the displacement of long-repressed anger at an old figure, I understood her eruption as an expression of both her buried desire to live without the sense of obligation to others' preferences and a long-suppressed aggressiveness that was beginning to gain expression. This way of construing her behavior was an interpretation not of the meaning of her past but of an incipient move toward a different future. I saw her rage as a step toward the realization of potential long dormant within her. (p. 99)

The strength of Summers’s work and his description thereof is exemplified in this moment: he is completely devoted to a developmental approach, in the best sense of that word. He articulates the great difficulty in creating the openness of potential space in therapy, and the great difficulty in not rescuing the patient from the terrible anxiety that ensues when she is faced with creating something new. Summers emulates Winnicott in his best work, being the attendant who waits upon and assists in a process of self-creation. The work requires exceptional discipline from the therapist, who must paradoxically hold an image of what the patient can become, while not impinging upon the self-creation process. This work, at its best, brings to mind those Winnicottian interpretations from Playing and Reality or Holding and Interpretation: all those times Winnicott said something like, "You need to hear from me now to know that I am here and alive but you also need me not to take away what is your own about this." Summers knows this approach inside and out, and he does not simplify or water down the great difficulty in being fully present without intervening, rescuing, or simplifying a matter of enormous import and complexity.

In this work, fully informed by developmental theory and research, Summers articulates a therapeutic approach which takes full account of the development of affect. Rightly here, he criticizes the classical Freudian description of affects as things. Affects are not things, he reminds us, but ways or modes of being. In pathological development, affects can become so rigidified and structuralized in impoverished patterns that they seem like irreducible things, the "rock bottom" of the unconscious. But in fact the point of therapy is to restore affective experience to its original open-ended multiplicity. One can simply say that the goal of therapy, for Summers, is for affects to become adverbs instead of nouns.

In Part 2 of Self-Creation, Summers gives four extended case histories that demonstrate the application of his theories to a variety of symptom presentations, including chapters on somatization, depression, intense self-criticism, and narcissistic despair. In each of these chapters, Summers demonstrates his encyclopedic knowledge of psychoanalytic literature, and gives an even-handed and respectful consideration to object-relations theory, self psychology, and relational psychoanalysis. Summers generously notes, in his concluding chapter, that life-transforming psychoanalytic cures can and do take place in therapies conducted without specific attention to his ideas about potential space, but he suggests that some of these transformative actions may be taking place in this space without explicit attention being paid by the therapist.

In this erudite and stimulating book, Summers demonstrates psychoanalytic theorizing at its best. Summers is an original thinker and, obviously, a compassionate and committed therapist. But he also serves as a model of how we can learn from each other, and how we, as theoretical pioneers, can explore the theoretical terrain of our colleagues without colonizing or laying waste to their lands. Of all the great gifts in this book, Summers offers this one throughout: he comes in peace.

Anthony, E. J. (1987). Risk, vulnerability and resilience: An overview. In E. J. Anthony and B. Cohler (Eds.) The invulnerable child. NY: Guilford Press, pp. 3-47.
Pizer, S. (2006). "Neither fish nor flesh": Commentary on Jon Mills (2005). Psychoanalytic Psychology, 23, 1, 193-196.
Winnicott, D.W. (1986/1972). Holding and Interpretation. NY: Grove Press.
Winnicott, D.W. (1971). Playing and Reality. London: Routledge.

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