CF 604, Epistemology I:
Foundations for Clinical Theories
Fall 2009
Joe Palombo
jp@josephpalombo.com
Goals
1. To make students aware of the foundations of clinical theories;
2. To familiarize students with the philosophical underpinnings of clinical
theories, such as positivism, post-positivism, hermeneutic theory,
constructivism, and neuropsychoanalysis;
3. To delineate the major controversies within these historical traditions, so as to enable students to evaluate particular clinical theories.
Objectives
1. To examine the nature of paradigms generally;
2. To survey some of the major modern philosophical movements and their
relevance to clinical theories;
3. To survey the various psychoanalytic paradigms so as to understand their underpinnings;
4. To develop some criteria as to what constitutes a sound clinical theory
within a psychoanalytic paradigm.
Assignments
At the beginning of each class, following the first one, members of the class will take turn
summarizing the content and discussion of the previous class. This summary cannot be longer
than 10 minutes. If the class has more than seven members, you may choose a partner with
whom to share in the presentation.
Please write a paper of about 15 pages on either of these two:
1. An area of your choice related to clinical paradigms, psychodynamic theories, or any other
clinical area in which you have an interest. You are required to integrate the material
discussed in class and to demonstrate that you have reviewed the relevant portion of the
literature and are thoroughly knowledgeable about it. You may use case material to
illustrate your point, but the paper should not be just a case presentation. The 15 page limit
should not include case material.
2. An outline of the clinical theory you favor. Using the outline discussed in class, spell out its
philosophical underpinnings, its root metaphor, and its primary view point for data
collection, and its metapsychology. Also, present a defense of your position, stating how
you would respond if you were to be criticized by someone who disagrees with you. You are
required to demonstrate that you have reviewed the relevant portion of the literature and are
thoroughly knowledgeable about it.
This paper is due on the last day of class for the semester, Saturday, January 16, 2010
It would help you considerably to read as much of the material before the start of class. Read
especially:
Kuhn, T. S. (1970). The Structure of Scientific Revolutions. Second Edition. Chicago,
University of Chicago Press. (This book is available on Amazon.com)
This bibliography is provided for reference and further study.
Class I. Introduction
Class II. & Overview
A. Freud's dream of a scientific psychology
*Freud. S. (1933) New Introductory Lectures on Psycho-Analysis. S.E. Vol. 22. Lecture 35, The question of a Weltanschauung (A View of the Universe). Pp. 158-162. PEP
*Hartmann, H.(1959), Psychoanalysis as a scientific theory. Hook, S. (Ed.) Psychoanalysis, Scientific Method and Philosophy. New York: New York
University Press. Pp. 3-37.
Rapaport, D. (1951), The conceptual model of psychoanalysis. Gill, M. (Ed) The collected papers of David Rapaport. New York: Basic Books. Pp. 405-431.
B. The components of a clinical theory:
1. Philosophical underpinnings: a) Positivist, b) Post-Positivist,
c) Hermeneutic, d) Constructivist.
*Guba, E.G., (Ed.), (1990), The Paradigm Dialogue. Newbury Park: Sage Pub. Ch 1, 4.
2. View Point:
a. Descriptive view point: Neutrality and the observational
field. The task in therapy is that of gathering
uncontaminated data by being free of countertransference
interferences. The field of observation is unaffected by the
observer. There is a reality which is apprehensible by the
observer.
b. Empathic/introspective perspective: Intersubjective& subjective viewpoints: Empathy or vicarious introspection:
Empathy defines the field: Vicarious introspection is the act
through which the contents of another person's mind is
apprehended. It is a process that leads to an understanding
of how people feel, how they think, how they perceive reality,
and how they give meaning to those perceptions. The
observer occupies an imaginary point within the object.
Attunement permits the observer to vicariously experience the affect states of the
other person.
*Kohut, H. (1959), Introspection, empathy and psychoanalysis. J. Amer. Psychoanal Assn. 7: 459-483 PEP
3. Root Metaphor: a) Mechanistic, b) Organismic, c) Contextual.
*Pepper, S. C. (1942), World Hypotheses: A study of evidence. Berkeley: University of California Press. Ch 5, Root Metaphors.
Palombo, J. (1996). Paradigms, metaphors, and narratives: Stories we tell about development. Journal of Analytic Social Work 4(3): 31-59.
4. Metapsychology:
a. Introduction
(1) It specifies a methodology and the data collection
tools that provide valid and reliable information about
the field of observation.
(2) It proposes a metapsychology derived from a body of
knowledge to which other disciplines have
contributed: Developmental psychology, cognitive
psychology, developmental psychopathology,
biogenetic, sociology, anthropology, etc.. The
metapsychology may be systematized into a general
psychology.
Gill, M.G. (1977), Metapsychology is not psychology. In Gill, M.M., & Holzman, P.S. (Eds) Psychology versus Metapsychology. Psychological Issues IX (4). New
York: International Universities Press. Pp. 71-105
b. Developmental theory
(1) must account for innate givens, potentialities. A
number of innate potentialities and competencies are present at birth. These manifest within a spectrum
that ranges from deficient to gifted. They include
among other things: Temperamental variations
(Chess & Thomas). Perceptual variations. Sensory
variations. Motoric variations. Variations in cognition,
interactions with others, and environmental factors:
(2) Its theory details the progression of the evolving
personality from infancy into senescence.
(3) The sense of self:
(a) The self is the structure that undergirds the
meaning and value systems which are
its content. It results from a person's effort to
organize experiences into a coherent "meaning
and value system".
(b) The maintenance of cohesion is the primary
task of the self.
(c) Affect theory:
i. Affects in the form of
sensations of pleasure or unpleasure related to
physiological relations, are innate in the
human infant.
ii Affects have a signal function
(Saari: communicative regulators'. P.70).
iii.
Affects lead to the evolution of a meaning
system through their contribution to the
organization of experience.
c. Theory of motivation (psychodynamics)
d. Theory of pathology: conflict or deficit.
(1) It proposes a theory of pathology which indicates the
manner in which derailments may occur during the
course of development that lead either to
dysfunctional states, or disorders of the self. Etiology
or genetic dynamic factors: Two competing view of
pathology have now emerged: One states that
pathology derives from unresolved conflict, and the
other states that it stems from developmental failures.
(2) Conflict models
(3) Deficit models
(4) Psychopathology is the result of deficits, distortion or
weaknesses in the sense of self (p.53). The evidence is
that the self is multi-fragmented, disharmonious,
depleted, devitalized, or enfeebled (p.60).
(5) Single traumatic events rarely play such a decisive
role in pathology as to produce the types of deficits
encountered in narcissistic personality disturbances.
It is rather the chronic multiple failures of the
selfobjects that lead to such deficits.
(6) The meaning of the experience is the paramount
factor in the effect an event has on the person.
(7) The affects surrounding that experience remain
unintegrated, and become the focus around which
symptoms are manifest.
(8) Symptoms: Symptoms are the expression of the
concretization of the experience of danger related to
the anxiety surrounding the loss of meaning or reflect
psychological or neuropsychological deficits.
*Kohut, H., & Wolf, E. S. (1978), The disorders of the self and their treatment: An
outline. International Jour of Psycho-Analysis 59:413-425. PEP
e. The treatment process:
(1) Its clinical theory proposes of a set of practice
principles through which: data is to be collected.
(2) Inferences are made from that data.
(3) Interventions which would bring about change in the
person are enunciated.
(4) The transference/countertransference configuration
is the key to the understanding of the therapeutic
process.
Stern, S. (1994), Needed relationships and repeated relationships: An integrated
relational perspective. Psychoanalytic Dialogues, 4(3)317-345. PEP
Lyons-Ruth, K. (1998). Implicit relational knowing: Its role in development and
psychoanalytic treatment. Infant Mental Health Journal 19(3): 282-289.
Class III. Philosophical underpinning: Positivism
A. Positivism
1. The scientific method: The natural science perspective. Quantitative
methods yield general laws about the workings of our universe.
2. View point: Descriptive view point: Neutrality and the
observational field.
3. The root metaphor: mechanistic or organismic.
4. Positivistic metapsychologies: Drive theory (Freud), ego psychology
(A. Freud, Hartmann), early object relations theory (M. Klein,
Kernberg), self psychology (early Kohut), information processing
theories (Basch)
Basch, M.F. (1988), Understanding Psychotherapy: The science behind the art. New
York: Basic Books.
*Leider, R. J. (1983), Analytic neutrality--A historical review. Psychoanalytic Inquiry,
3(4): 665-674. PEP
B. The critique of positivism:
1. The nature of paradigms: Kuhn on scientific revolutions.
2. Normal science and anomalies
3. The developmental phases of paradigms
4. The scientific revolutions
5. The incommensurability of paradigms
6. The nature of data
7. World views
*Kuhn, T. S. (1970) The Structure of Scientific Revolutions. Second
Edition. Chicago, University of Chicago Press.
C. The post-positivist response:
1. Regularities exist in the universe but we can only obtain
probabilistic results
2. There is a universal method for conducting inquiries into the
natural and human realms.
3. Quantitative and qualitative methods can be combined to answer
questions
4. Although the concepts the observer uses to explore the universe are
invention there are limits to the extent to which the observer affects
what he or she observes
5. The worlds we construct in our inquiries are "possible worlds"
D. Relevance to Qualitative Research
Schwandt, T. A. (1995). Constructivist, interpretivist approaches to human inquiry. In
N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of Qualitative Research (pp. 118-137). Thousand Oaks, CA: Sage Publication.
Schwandt, T. A. (2000). Three epistemological stances for qualitative inquiry:
Interprietivism, hermeneutics, and social constructivism. In N. K. Denzin & Y. S.
Lincoln (Eds.), Handbook of Qualitative Research, Second Edition (pp. 189-213).
Thousand Oaks, CA: Sage Publication.
*Guba E.G., (Ed.), (1990), The Paradigm Dialogue. Newbury Park: Sage Pub. Ch 2,
Post-positivistic Science: Myths and Realities. Pp. 31-45.
Class IV. Philosophical underpinnings: Hermeneutics
A. Natural science Vs Human science perspective.
1. Meanings are central to understanding human beings and human
motivation.
2. Viewpoint: The empathic/introspective method of observation.
3. Root metaphor: The role of textual interpretation: the contextual
metaphor. Understanding the meaning of a text as the central
concern. Qualitative methods can yield statements about the
regularities in our universe.
*Dilthey, W. (1986) The understanding of other persons and their life-expressions. In
Mueller-Vollmer, K., The Hermeneutic Reader: Texts of the German tradition
from the Enlightenment to the Present. London: Basil Blackwell.
B. Hermeneutic metapsychologies: self psychology (Later Kohut),
intersubjectivity theory (Stolorow).
*Stolorow, R. D., Brandschaft, B., & Atwood, G. (1987) Psychoanalytic treatment: An
intersubjective approach. Hillsdale, N.J.: The Analytic Press
C. Critiques of hermeneutic perspectives.
Sass, L. A. & Woolfolk, R. L. (1988) Psychoanalysis and the Hermeneutic Turn: A
critique of Narrative Truth and Historical Truth. Pp. 429-453.
Class V. Philosophical underpinnings: Constructivism
A. The social construction of reality
1. Viewpoint:
a. The relativity of all world views. Qualitative methods
determined by the investigator yield statements about the
context of inquiry
b. The observer affects what he or she observes
c. All inquiry is governed by the values the inquirer bring to the
task
2. Root metaphor: Total contextualism.
3. Constructivist metapsychologies: Gill, Hoffman, Mitchell
*Cushman, P. (1991) Ideology obscured: Political uses of the self in Daniel Stern's infant.
American Psychologist 46(3)206-219
*Eagle, M. (2009). Postmodern influences on contemporary psychoanalysis. In R. Frie& D. Orange (Eds.), Beyond Postmodernsims: New dimensions in clinical theory
and practice (pp. 27-51). New York: Routledge.
DeYoung, P. A. (2003). Relational Psychotherapy. New York: Brunner-Routledge.
*Lincoln, Y. S. (1990) The making of a constructivist: a remembrance of transformations
past. From E.G. Guba (Ed.) The Paradigm Dialogue. Newbury Park, Sage
Publications.
Hoffman, I. Z. (1992), Some Practical Implications of a Social- Constructivist view of the
psychoanalytic situation. Psychoanalytic Dialogues. 2(3):287-304. PEP
Scarr, S. (1985), Constructing Psychology: Making facts and fables for our times.
American Psychologist, 40(5):499-512.
*Gergen, K. J. (1985) The Social Constructionist Movement in Modern Psychology.
American Psychologist 40(3):266-275.
4. The social construction of reality
a. The relativity of all world views. Qualitative methods
determined by the investigator yield statements about the
context of inquiry
b. The observer affects what he or she observes
c. All inquiry is governed by the values the inquirer bring to the
task
d. Constructivist metapsychologies: Gill, Hoffman, Mitchell
e. Constructionist metapsychologies: Gergen,
5. Lincoln & Guba's Six principles of constructivist research:
a. All facts are “theory laden.”
b. No theory can ever be fully tested because of the problem of
induction.
c. Inquiry cannot be value free.
d. the observer affects the observed.
e. Qualitative methods Vs quantitative methods.
f. Relevance rather than rigor as a criterion for research.
6. Lincoln's constructive principles:
a. Reality is a social construction, therefore there are multiple
realities.
b. The aim of constructivist science is to create idiographic not
nomothetic knowledge--expressed a pattern theories.
c. Subject/object dualism and objectivism are replaced by
interactive monism. The interaction between observer and
observed must be recognized.
d. Methods of research designed to capture realities holistically,
to discern meaning implicit in human activity. The design
for such inquiry can never be fully articulated until after the
inquiry is completed.
e. Switch from rigor to relevance.
f. Paradigms are world views embedded in the socialization of
adherents. Accommodation between paradigms is
impossible.
g. Inquiry can never be value free.
7. Lincoln solution to the problems constructivism presents:
a. Paradigms must be judged by their comprehensiveness:
Conventional science is inappropriate for the social sciences,
but what of research that utilizes a mixed method design?
b. Traditional science methods lead to unacceptable social
consequences. The shift in paradigms is to a more "democratic form of inquiry" where researchers and subjects
are co-participants in the study.
c. Knowledge is culturally situated in nature. All methods are
social inventions.
d. There multiple ways of knowing: There are differences in
perspective, plurality of color and ethnicity lead to different
constructions of the world. This frees the researcher from
the dogma of objectivity.
e. Legitimation of research is attained through the "joint
reporting" with the subjects checking the data and findings.
f. The purpose of research is not prediction or control but "verstehen."
B. Critique of the social constructivist perspective
Bornstein, R. F. (2004). Reconnecting psychoanalysis to mainstream psychology: An agenda for the 21st Century. In J. Reppen, J. Tucker & M. A. Schulman (Eds.),
Way Beyond Freud: Postmodern psychoanalysis observed (pp. 1-19). London:
Open Gate Press.
Class VI. Philosophical underpinnings: Neuropsychoanalysis
A. Freud Revisited
1. Revival of Freud’s Project
Schore, A. N. (1997). A century after Freud's Project: Is a rapprochement between
psychoanalysis and neurobiology at hand? Journal of the American
Psychoanalytic Association, 45(3), 807-840. PEP
2. Can psychoanalysis and neuroscience be integrated?
a. Kandel:
(1) The nature of the dynamic unconscious.
(2) The problem of psychic determinism
(3) The role of development in psychopathology.
(4) The causes of psychopathology.
(5) Does psychotherapy produce brain change?
(6) Psychopharmacology and psychopathology.
Kandel, E. R. (1998). A new intellectual framework for psychiatry. American Journal of Psychiatry, 155(4), 457-469.
3. The relevance of neuroscience to clinical practice.
4. The agenda for a new paradigm: The integration of two disciplines:
psychoanalysis and neuroscience
B. The Paradigm: Neurodevelopmental perspective
1. Philosophical underpinning: Post-positivism–nonlinear dynamic
systems
2. View Points: Multiple–descriptive, interpersonal, and empathic
3. Root metaphor: Organismic–evolutionary perspective
4. Metapsychology:
a. Development: Neurodevelopmental perspective
(1) Impact of neuropsychological strengths and weakness
on development
(2) The effects of relationships on development
(3) The intrapersonal integration of experience
b. Personality: results from interaction between nature and
nurture
c. Psychopathology: innate factors contribute to dysfunctional
states
d. Cure: brain changes result from talk therapy
Cozolino, L. (2002). The neuroscience of psychotherapy: Building and rebuilding the brain. N.Y.: W. W. Norton.
Applegate, J. S., & Shapiro, J. R. (2005). Neurobiology for Clinical Social Work: Theory
and Practice. NY: W.W. Norton.
Palombo, J. (2001). Learning disorders and disorders of the self in children and
adolescents. NY: W.W. Norton. Chs. 1-6.
C. Critiques of Neuro-psychoanalysis.
1. The mind/body problem
2. Differentiating mind from brain function
3. Left over anomalies
Class VII. The diagnosis of pathology: conflict or deficit.
A. Conflict models
B. Deficit models
C. The treatment Process.
1. The transference/countertransference configuration is the key to
the understanding of the therapeutic process. There are three
components to this configuration:
2. The concordant positions and responses:
3. The complementary positions and responses:
4. The disjunctive positions and responses.
D. Clinical issues.
1. The defense transference.
2. Clarification
3. Interpretation of resistances against regression.
4. Interpretation of defenses:
5. Understanding must precede Interpreting.
E. Nature of interpretations:
1. What is interpreted?
2. Working through.
3. Countertransference considerations:
4. Curative aspects.
5. Constructions and reconstructions.
6. Termination
Class VIII. Review and questions