Approaching Primary Process Thinking with Secondary Processes Blazing

Transcription

1 Approaching Primary Process Thinking with Secondary Processes Blazing Primary Process Thinking: Theory, Measurement, and Research By Robert R. Holt United States of America; Jason Aronson, pp. + CD. ISBN (book)/ ISBN (electronic) Reviewed by Harriette Kaley Harriette Kaley, 14 2 East 71 St., New York, N.Y dr.h.kaley@gmail.com

2 This extraordinary, useful and, yes, daunting book is the result indeed, in an important sense, the culmination-- of a long and productive professional lifetime of work. The author, now in his 90s and intellectually undiminished in any discernible way, notes that the book crowns about fifty years of intermittent effort to understand, clarify, and put to work the psychoanalytic theory of thinking. (vol. 1, p. vii). It offers an expert, closely-reasoned, detailed critique of that theory as originally promulgated, proposes an alternate version intended to avoid the pitfalls of that theory, and then offers an ingenious, creative, multi-faceted manualized system that the author and his collaborators have developed over the years for scoring primary process manifestations in Rorschach responses. 1 It is a book that demands attentive reading and that repays it by introducing a method that is at one and the same time a research tool and a way of sharpening clinical awareness and is itself a codification of Holt s sophisticated understanding of how primary process thinking reveals itself in actual clinical work. It has been well over forty years since I was one of Holt s dissertation students and one of the people he trained in scoring the Rorschach using the method that this book presents. Full disclosure requires acknowledging that it was one of my formative training experiences, and the basis for a lifelong appreciation for the psychological strengths and efforts at recovery and repair that often accompany the most seemingly disturbed productions. It taught me about nuance and subtlety of thought, about easily-overlooked ways people have of guarding, moderating and minimizing problematic material as it arises in their productions, about creativity and other adaptive processes intertwined with psychological struggle. It put pathology in its proper place, a place far less central 1 The scoring system has also been applied to Thematic Apperception Tests, dreams and free texts. The CD includes those manuals as well as the Rorschach manual.

3 than it is usually given clinically, a place where it exists alongside all sorts of respectworthy processes of control and defense. It also provided a grounding in the necessity, for clinical and research purposes, of dealing with real, concrete manifestations of underlying thought processes, not in abstractions about thought processes. It has stood me in good stead for all this time. And a good thing, too, because mastering the system requires no small amount of dedication. The book itself is unusual in format. It consists of two volumes. The first is a hardcovered book of some 150 pages. The second is a CD, contained in a sleeve inside the book s back cover, of 847 pages. The book masterfully summarizes and gives a detailed critique of psychoanalytic theories of thinking, presents Holt s more scientificallyacceptable synthesizing reformulation, provides the theoretical rationale for the scoring system, and goes into several fascinating digressions into related areas. The CD has the scoring system itself, with its intricate manual; several scored Rorschach protocols for self-training purposes, along with step-by-step detailed discussions of each response and each score; 2 and a series of chapters on validity, reliability and various clinical and research projects that have used the system. Few people other than dedicated researchers will need to read every word in either volume, but it testifies to the author s meticulous care that the information is there in such detail. What Holt considers the relevant literature is far-ranging, and includes the theoretical and empirical, the psychoanalytic and neurological, all reviewed through 2002; it appears that the book took on its final form in 2004, although obviously it took more time to bring it to publication. 2 It also includes an invitation to contact the author himself electronically if additional help is needed.

4 Why, one might ask, is such massive detail necessary? The reason is that Holt is at pains not just to showcase the scoring system but also to assemble the voluminous data on its use to date, permitting the individual reader to evaluate them on his or her own. Holt also undertakes to bring the reader along the path that he himself has traveled in trying to understand the psychoanalytic theory of thinking as it emerged from Freud s writings. That path has not been a simple or straight one, and the book presents the author s struggles to understand psychoanalytic theory and its metapsychology and at the same time to apply it to practical, everyday clinical necessity, starting from doing psychological testing in a VA hospital. Along the way, he concluded that psychoanalytic metapsychology that magisterial, ornate conceptual structure replete with concepts like psychic energy, so beloved of earlier generations of psychoanalysts-- could not be justified in its then-present form. Such questioning can not have come easily to him; there are numerous respectful, even loving, references to his psychoanalytic mentors and friends, especially David Rapoport and Benjamin Rubinstein, and Holt is scrupulous about showing how his increasingly critical view of the metapsychology came about only as the result of cumulative understanding based on research and an increasingly sophisticated understanding of scientific approaches. In the end, Holt s hope is that the book s implications for the future of psychoanalysis may become known (vol. 1, p. 86, italics in the original) and that it serve psychoanalytic science (vol. 1, p. 88) well by showing that some of Freud s concepts can be made operational. His scoring system, accordingly, can be employed without loyalty to any particular brand of psychoanalysis. He writes:

5 (T)he professional who uses the resulting data may have any of the currently common theoretical orientations: neobehaviourist, classically Freudian, Sullivanian, self-psychological, object- relational, Adlerian, eclectically psychodynamic, whatever., Data from tests, like transcripts of interviews, are basically theory-neutral, capable of being put to the service of almost any theoretical outlook. (vol. 1, p 48). What then is the scoring system, and what, come down to it, is primary process thinking? The second question is harder to answer; at the risk of tremendously oversimplifying, it is, for purposes of the scoring, indications in Rorschach responses of relatively primitive cognitive functioning, including motivational (what used to be called manifestations of drive ) and formal aspects, and affects, defense and control. It is found on a kind of continuum, with rational logical scientific secondary process thinking at the other end, The primary process manifestations in Rorschach responses are assessed in terms of formal considerations as well as the content (sexual,. aggressive) of the verbatim responses, taking into account the old standby of form level, but also looking to context, creativity, sequence, reflectiveness on the part of the subject, and an impressive variety of other means of containing and modulating raw material. It is difficult to do justice with this description to the delicacy and psychological penetration of the scoring system. The way it calls the scorer s attention to otherwise overlooked indications of primary process thinking is itself worth the price of admission. And that price, as noted, is not cheap: with its two levels of content and formal variables, its control and defense scores, and the other intricacies of scoring, mastery is not quick. But the results, as obtained from many studies in many geographical locations within and outside the United States, commend it not only for its usefulness but for the ways it

6 sheds light in dim corners. For instance, it is subtle enough so that the results for a group of unemployed gay actors show many details (e.g., unusual associative flexibility [vol.2, p. 650]) that support Holt s assertion that the system supplies techniques of analytically dissecting people s defenses and coping resources. (vol 2, p. 14). In the end, this book provides exemplary demonstrations of the application of scientific rigor and the payoff from years of devoted concentration on a grand but humbling topic. It is a fitting capstone to Holt s lifelong pursuit of a meritorious goal: finding a way to study that most elusive of psychological phenomena thought. Biography of Reviewer Harriette Kaley received her PhD from New York University in 1969 and her certificate in psychoanalysis in 1975 from the New York University Post-Doctoral Program. She taught for over thirty years at Brooklyn College-City University of New York and is now professor emerita. Currently in private practice in New York, she is active in professional organizations and is a past president of the American Psychological Association s Division of Psychoanalysis (Division 39).. She has published on a variety of psychoanalytic topics, including dreams, women s issues and transference and countertransference. In 2006 she received her master s degree from the Bard Graduate Center for Studies in the Decorative Arts, Design and Culture, with a thesis on Freud s collection of antiquities.. Author/review/holt