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Int. J. Psycho-Anal. (1989) 70, 65

CONFLICT AND DEFICIT: IMPLICATIONS FOR

TECHNIQUE

BJ0RN KILLINGMO, OSLO

INTRODUCTION forces in pathological phenomena (Killingmo,

1985). Finally, the mechanism of pathology
In traditional psychoanalysis psychopathology seems not always to be one of forces actively
is conceptualized in terms of intersystemic con- opposing each other as stated in the traditional
flict. This implies various patterns of opposition theory. It may also be one of passive trauma or
between the three structural systems of suffering. The pathogenic contribution of the
personality-id, ego, superego-and reality. environment is not primarily moral condemna-
Furthermore, the main formula of pathological tion opposing the child's drive wishes. Rather, it
development proceeds thus: oedipal drive wish is a question of failure, the object not being
-+ repression -+ regression -+ symptom forma- emotionally responsive in a phase-adequate
tion. This way of conceptualizing pathology way to the developmental needs of the child.
presupposes a certain degree of structural dif- On the level of principle, therefore, we shall
ferentiation. First of all the very systems which have to speak of two separate mechanisms of
are supposed to be in conflict with each other pathology, that of conflict and that of deficit.
have to be separated. Secondly, a relatively Unlike the typical pathology based on conflict,
stable differentiation between self-representation pathology based on deficit is characterized by
and object-representation (constancy) has to be intrasystemic failures such as defective self-
established in order to experience the triadic structure, lack of object constancy, identity
interpersonal constellation of the oedipal situa- diffusion, splitting, and lack of capacity for
tion. Thirdly, the individual must have reached emotional relating to objects (Kern berg, 1975),
a level of structural development which allows that is to say that the very development of the
for utilizing repression as the main mechanism ego structure has been damaged.
of defence. The widening scope of psychopathology men-
However, both clinical experience and theo- tioned above, is mainly a result of theoretical
retical development, especially over the last 20 development within object-relations psychology
years, seem to call for a revision or at least an and self-psychology. Obviously, this new
extension of the classical theory. First of all, a look challenges the state of monopoly
huge amount of clinical evidence tends to point which the concept of conflict has occupied in
to an onset of pathology before the above traditional theory. Roughly, three theoretical
mentioned structural differentiation is supposed positions as to the status of the concept of
to have taken place (Call, 1980). Next, the very conflict seem to prevail in contemporary psycho-
needs at stake in the pathological process do not analysis:
always seem to be primarily of a drive nature (l) Conflict is to be conceived of from birth.
(libidinal or aggressive). Also developmental In the end all psychopathology is based on
needs (Tolpin, 1978), like the need for symbiotic intrapsychic conflict. In principle, psycho-
merger (Mahler et al., 1975) or the need for analysis as a treatment procedure is applicable
affirmation of basic self-feeling (Kohut, 1977), over the whole range of pathology. This would
may play an independent part as motivating be the Kleinian position.

3-2
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66 BJ0RN KILLINGMO
(2) Conflict should be restricted to the tradi- tion both from patient to patient and within one
tional intersystemic one. Psychoanalytic treat- and the same patient from one point of time to
ment also should be restricted to conflict-based another or from one area of personality to
pathology. Developmental deficit belonging to another. Secondly, to discuss how this widening
the earlier undifferentiated stages of develop- scope of psychopathological understanding will
ment strictly speaking falls outside the specific affect the standard psychoanalytic approach.
theoretical domain of psychoanalysis. This Within this perspective, the following problems
seems to be Anna Freud's position (1981). will be discussed more specifically:
(3) The concept of conflict should be supple- I. What differences in therapeutic strategy
mented by the concept of deficit in a broad does the distinction between conflict and deficit
theory of structural development. Psycho- bring about?
analysis in its classical form fails to cope with 2. How is transference affected by conflict
the whole range of structural pathology en- and deficit respectively?
countered in clinical practice. A widening scope 3. How do derivatives of deficit appear in the
of analytic technique is therefore needed. This clinical material?
'third point of view' seems to be, if not openly 4. Does the concept of deficit by implication
stated, at least implied by several contemporary involve a modification of the analytic attitude?
theorists (Gedo, 1981; Robbins, 1983; Tiihkii,
1984). It is also the point of view of the present
author (Killingmo, 1985). Two THERAPEUTIC STRATEGIES
The third point of view implies that
personality structure has to be thoroughly As mentioned above, the concept of inter-
assessed in every single case. The analyst! should systemic conflict presupposes some degree of
derive his therapeutic strategy from an under- differentiation between the systems of id, ego
standing of the unique structural make-up of the and superego. In addition a differentiation must
patient and formulate and apply his inter- have taken place within the ego itself. This
ventions so that they match this very structure. includes a certain ability of representation as
In order to accomplish this task in a consistent to:
manner, the analyst would need a theory allow- (I) The relationship between cause and cir-
ing for a detailed description of structural un- cumscribed effect.
evenness, that is varying constellations of (2) The self as an initiator of thoughts and
developmental arrest and conflict and their ensu- actions.
ing organization and hierarchical structuring. (3) The self as separated from other objects
Equipped with such an instrument for under- and happenings.
standing clinical data, the analyst would be in Given these structural assets we can imagine a
a position to amplify his interventions more child being able to experience that a certain
exactly to the state of the ego at any given 'bad' event took place for a certain reason and
moment of time in therapy. Perhaps this is an that he himself had something to do with it
ideal state of affairs we shall never reach. On the happening, simultaneously knowing that he was
other hand, it will always be possible to refine 'not all at fault' (Myerson, 1981). The ego has
both structural evaluation and therapeutic inter- developed to a level where it is capable of
vention as well as our understanding of the experiencing and representing primary inten-
relationship between the two. tionality. That is, the self-representation has
The purpose of the present paper is twofold. been constituted as a responsible centre for the
First, to discuss how the conceptual distinction child's own impulses, feelings and actions. (I
between deficit and conflict may contribute to a shall later return to the question of secondary
refined understanding and therapeutic handling intentionality.) This child, being able-at least
of varieties of structural patterns, that is varia- in a rudimentary fashion-to conceive of himself

1 In this paper the term 'analyst' is used even if the technical interventions applied fall outside what is commonly
considered standard psychoanalysis.
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CONFLICT AND DEFICIT 67

as an agent in his own life, also will have the have resisted realizing, is --'. Even if un-
capacity to be afraid of his own bad intentions. pleasant, the patient will be able to accept the
Consequently, ego will institute means of self- invitation to search into latent meaning as a
deception, mainly repression, to avoid finding basically helping attitude from the analyst.
out for whom he feels what. Thus we can However, working with derivatives of deficit,
conceptualize the essence of conflict-based the analyst cannot without further ado expect
pathology as one of concealed meaning. the patient to experience his invitation to enquiry
The main difference between conflict and as a benevolent helping act. It is more likely to
deficit can be formulated in terms of representa- be interpreted in terms of critique, provocation
tion of intentional meaning. Thus, deficit will or attack. This will weaken the working alliance
refer to pathology where primary intentionality and ultimately be a threat to the continuation
is lacking. Due either to overwhelming stimu- of therapy. Thus, concerning deficit-based
lation, or inadequate stimulation or to depriva- material, the therapeutic perspective is not
tion, the ego has been injured at a time when primarily topographic but one of (1) correction
the ability to represent cause and effect and the and separation of distorted or diffused self-
ability to experience the self as a strategic centre object representations, and (2) bringing about
have not yet been developed. The result of this structuralization of aspects of object relations
lack of ego differentiation is a state of confusion which has not yet been accomplished in the
and amorphous feelings of shame and guilt. previous development. For this purpose the
Thus, in pathology based on deficit, it is not a interventions of the analyst have to be, not of an
matter of defending oneself against anxiety con- interpretive, but of an affirmative nature.
nected with bad intentions, e.g. forbidden What are the characteristics of an affirmative
object-directed needs, fantasies and feelings, as intervention? The four elements listed by Cissna
is the case in conflict. What is defended against & Sieburg (1981) seem to establish the psycho-
is primarily anxiety of fragmentation, i.e. losing logical essence of the concept: (1) the element of
one's own feeling of identity. existence, (2) the element of relating, (3) the
What implication does this differentiation element of worth and (4) the element of validity
between conflict and deficit have for therapeutic of experience. An affirmative intervention does
strategy and type of intervention? As regards not always include all of these elements, but may
conflict pathology, the task of the analyst is to emphasize one of them. Thus, sometimes the
assist the ego in the risky venture of confronting validity of experience will be the urgent
archaic impulses and affects towards internalized experiental quality to be confirmed. A relevant
object representations which are projected on to intervention would go along the line: 'What you
the analyst. Such an undertaking presupposes are feeling makes good sense. In that situation
an alliance between analyst and patient in finding you had no other choice. The best you could do
out, that is, searching for concealed meaning. was to do exactly as you did'. The affirmative
However, concerning deficit pathology, the quality may be conveyed by interventions of
therapeutic endeavour is not primarily to unveil different logical and contextual complexity,
repressed meaning, but rather to assist the ego in ranging from simple statements like: 'What you
experiencing meaning in itself. It is not a matter saw must have been most confusing to you', to
of finding something else, but to feel that some- more comprehensive reconstructions aimed at
thing has the quality of being. undoing false connexions both emotionally and
Working within the domain of conflict-based cognitively.
material, the analyst expects the patient to be Several terms have been used in referring to
allied in investigating both the conflict and the interventions other than traditional interpreta-
resistance against the investigating endeavour tion. Thus, Ornstein & Ornstein (1980) speak of
itself. The therapeutic perspective will primarily 'empathic reconstructive-interpretation', Tahka
be a topographic one and the interventions of an (1984) of 'empathic explanation', while others
interpreting nature along the formula: 'What seem to use 'reconstruction' as the other broad
you have been wishing and at the same time category of intervention next to interpretation
been scared of and felt guilty about and therefore (Sandler, 1984). I would suggest that all these
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68 BJ0RN KILLINGMO
terms should be subsumed under the heading of ation, rigidity and stability of the transference
affirmative interventions. In my opinion this are highly relevant. These aspects, conveying
broad category would also include terms like information about the level of structural
'containing' (Bion, 1962) and' holding' (Modell, organization, are not stressed in the Kohutian
1976; Winnicott, 1965). Even if these terms have term. Another objection is that the concept of
other aspects as well and also refer to more selfobject transference as explained by Kohut,
implicit aspects of the analyst's behaviour, they implies a notion of the analyst as only a tool for
nevertheless contribute to establishing an structure building, neglecting his position as an
experiental quality of meaningfulness. Certainly object also for drive-related actions and affects
the affirmative quality is not dependent on (Curtis, 1983). Finally, the analyst not only
words. It may well be conveyed by saying serves as a 'midwife' for the birth of a coherent
nothing in the right way! self-representation, he is also the model for a
To conclude. On the level of principle we may whole range of other ego functions. Thus, we
distinguish between two types of therapeutic need more inclusiveconcepts and in what follows
strategy: (1) revealing meaning and (2) establish- I shall use the terms conflict transference and
ing meaning; the first one being primarily rele- deficit transference respectively.2
vant in contexts of conflict, the second in con- How does conflict transference differ from
texts of structural deficit. For the purpose of deficit transference? Corresponding to the
revealing meaning the relevant type of inter- elaborate level of structural differentiation
vention is interpretation, while establishing involved in conflict, transference originating in
meaning is brought about by interventions of an conflict will also be of a differentiated nature. In
affirmative type. conflict we are dealing with impulses and affects
aimed at internalized representations of former
important emotional objects of the person's life
Two PATTERNS OF TRANSFERENCE history. These representations and the various
needs attached to them are unconsciously pro-
Following the mode of reasoning presented jected on to the analyst with the expectation of
above, it becomes an important task for the being gratified by him. Formally, they constitute
analyst to decide whether the material at hand is whole, separated and specific object representa-
primarily based upon conflict or upon deficit. In tions embedded in complex patterns of object
making this decision, qualitative aspects of relations. In addition they are structured under
transference may serve as a guideline. the impact of the reality principle so that they
Within the Kohutian tradition a distinction will not severely disturb the therapeutic alliance
has been made between object transference and or overshadow the reality aspect of the thera-
seifobject transference (Ornstein & Ornstein, peutic situation.
1980). Roughly, the first refers to transference Through internalizing aspects of the object
deriving from conflict while the other refers to and 'transmuting' them into unpersonalized
derivatives of deficit. However, for the present enduring structures, the individual obtains rela-
purpose, the usefulness of the concept of self- tive independence from the direct presence and
object transference may be questioned. Refer- gratification of the object. Thus, the compulsive
ring only to three patterns of narsissistic dependency on the object's approval will
transference, 'mirroring', 'idealizing' and diminish as far as affirmative functions of the
"twinship ' (Kohut, 1984), the concept seems too object are structuralized. If internalization of
confined to encompass all kinds of transference object representations and object functions has
of distorted object relations connected with not been completed, the individual will prevail
deficit pathology as for example 'merger'-trans- more or less in a prestructural (functional)
ference (Hedges, 1983). Next, not only the con- relation to the object. This is the essence of
tent of the transference is of clinical interest, but transference originating from deficit. Unlike
also formal aspects like coherence, differenti- conflict transference, deficit transference is not

2 This distinction seems roughly to parallel that of Takha between 'structural' and 'prestructural ' transference (1984).
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CONFLICT AND DEFICIT 69

charged with specific representational content. the level of conflict. However, pathology
It is rather a matter of direct externalization or originating at the levelof deficit may also present
repetition of undeveloped or distorted structure. a quality of intentionality-but here as a
Thus, in principle, conflict transference refers secondary phenomenon. Initially, the child has
to repetition of needs directed towards object no intentional participation in the trauma, but
representations while deficit transference refers as an act of later organization he may
to repetition of needs directed towards objects transfer bad intentions from other conflictual
not being internalized. Clinically, however, relations to the trauma in order to supply an
deficient structuralization differs in degree and otherwise confusing or terrifying experience
extent. Thus, a person may remain in a pre- with meaning. After all it may make the world
structural relation as to certain functions or more tolerable for a little boy that mother left
aspects of the object while others have been him because he was a bad boy than facing the
'carried over' on a structural basis. From a fact that she simply left him. In addition, this
therapeutic point of view, we may say that the plain reality would probably have set up a rage
patient in a deficit transference is a person in of such a threatening nature, that it is more safe
need of an object able to provide the proper to put the blame on oneself. So, we may speak of
conditions for correction of distorted object two types of guilt feelings: (I) one based on bad
representations and for internalization of object intentions which are initially experienced as
functions. This is a precondition for further belonging to oneself and (2) one based on bad
structural differentiation to take place. intentions which are self-imposed later to
The foregoing discussion may have left the eliminate confusion. The two have different
impression that conflict transference and deficit sources, but at the clinical level they may appear
transference are different psychological pheno- pretty much alike and have comparable dynamic
mena. However, the difference is more on the effects. It is only through subtle aspects of the
conceptual level than on the level of clinical transference that the difference in origin may be
observation. By definition deficit transference traced.
refers to an emotional orientation without According to how the organizing process
specific object-directed content. Still, in clinical proceeds, different combinations of deficit and
practice it will not appear so. Like conflict conflict may arise. Secondary intentionality
transference, deficit transference will be charged demonstrates how deficit acquires meaning by
with meaning which is projected on to objects. being interpreted in terms of conflict. Derivatives
The reason for this is that in psychic life an of deficit may also create or initiate conflict, as
organizing process is always taking place when aggression is structurally too undifferen-
(Killingmo, 1985). Through this process, struc- tiated (unneutralized) to form a compromise
tural defects originating from early traumas will with normal parental restrictions or when
be organized within later structures of conflictual previous deprivations have left behind a hunger
origin and thus acquire meaning in continually for objects of such an intensity that it will not be
changing contexts. In the adult the organizing able to find gratification in mutual love relations.
process has been going on for a long time- In general, structural deficit will have a tendency
combining derivatives of deficit and conflict in to intensify ordinary developmental conflicts.
such complex patterns of character-that it is Thus, castration anxiety of the oedipal conflict
almost impossible to distinguish the one sharply may acquire a dimension of disaster or total
from the other. failure when a previous fragmented self is added
What I shall call 'secondary intentionality' to the picture.
may serve as an example. In a previous section, As long as derivatives of dynamic conflict and
the concept of primary intentionality was intro- derivatives of structural defects are organized in
duced, referring to a rudimentary ability of the complex patterns, they should not be regarded
ego of the child to experience the self-representa- as separate components added together but
tion as responsible for needs and feelings. This rather as different aspects of uniform pheno-
structural differentiation is supposed to be a mena. This point of view seems to be on the line
precondition for development of pathology at with Wallerstein: 'For in the flow and flux of
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70 BJ0RN KILLINGMO

analytic clinical material we are always in the The patient, a female of28 years, has come for
world of "both/and". We deal constantly, and treatment owing to a chronic feeling ofemptiness
in turn, both with the oedipal, where there is a and lack of joy. She is functioning very com-
coherent self, and the preoedipal, where there petently in her profession as a nurse. However,
may not be; with defensive regressions and with she has had no intimate relationships with men,
developmental arrests; with defensive trans- and even though she has a great many girlfriends,
ferences and defensive resistances and with none of them are emotionally close and she has
recreations of earlier traumatic and traumatized a constant feeling of loneliness. She is the eldest
states' (1983, p. 564). Following this mode of of five children and was from a very early age
reasoning, the sharp distinction between conflict expected to take care of her younger siblings,
transference and deficit transference should also however, without getting any credit or privileges
be cancelled. When they are to be applied in the in return. The mother seems to have been a very
clinical situation, it seems more relevant to view egocentric and unreliable person, having little
them as expressing different qualities of trans- affection for her children and at the same time
ference than as different forms of transference. demanding strict discipline. The patient was
never convinced that she had her mother's
approval. As soon as the mother became dis-
CLINICAL IMPLICAnONS satisfied with the children, and especially with
the patient-who as the eldest was supposed to
The therapeutic implications of the distinction behave herself-she would suddenly leave the
between deficit and conflict make the listening of house. The children were left behind anxiously
the analyst all the more important. In addition waiting for her to return, without knowing if
to screening the clinical material for unconscious and when this would happen.
meaning, the therapist continuously has to let The patient had been in psychoanalytically-
the material pass through a process of judging oriented psychotherapy for three years. The
the degree of structural differentiation reflected transcript is derived from a phase in therapy
in it. Certainly, this is not a process of conscious where a point of stagnation had been reached.
decision. In the experienced clinician it is a Session by session the patient repetitively insisted
highly automatic way of perceiving-which that the analyst should tell her what he was
forms part of free floating attention. However, thinking about her when he was sitting silently.
even the most experienced clinician may easily On numerous occasions and in different ways
miss subtle cues pointing to derivatives of deficit. the analyst had commented on the insisting
At face value the material may seem to originate quality of her demands and encouraged her to
in conflict leading the analyst to intervene on a try to find out what needs were expressed by this
level which is too high as regards the level where attitude. These comments, however, were regu-
the emotional core of the material is organized. larly experienced by the patient as a rejection
By doing so, he no longer remains available to which in turn resulted in all the more
the patient who consequently cannot profit from demandingness. The sequence chosen for illus-
the intervention. tration runs as follows.
As already stated, the distinction between 1. A.' My invitation was that together we
conflict transference and deficit transference should take a look at what is hap-
may be helpful as a conceptual tool in judging the pening inside you in this situation. It
material at hand. Still the question remains: is as if that perspective has been lost.
How are the derivatives of deficit reflected on 2. P.' Yes, it has. I only feel that you have
the clinical level, what are the clinical signals for got it in for me.
the therapist to pick up? In what follows, a short 3. A.' Useful that this comes out, isn't it?
sequence from a therapeutic dialogue will be After all, it demonstrates how unsure
presented. The purpose of the clinical illustration you are of me and how under pressure
is to highlight the problem of matching the you feel, so that the working perspec-
therapeutic intervention to the structural level of tive we had is lost. And I guess the
the patient and to demonstrate some character- same happens outside the therapy
istic qualities of deficit transference. too?
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CONFLICT AND DEFICIT 71

4. P: Yes, it does. But outside I don't care. clearcut example of structural mis-
But here it is different. Here every- match.
thing is pushed to the limit. No.3: However, A does not perceive that he
5. A: Yes, and isn't that useful? It gives us is no longer emotionally available to
an opportunity to work on it here. P. On the contrary, by introducing the
6. P: Yes, but it makes me very insecure. word 'useful', A expects P to adopt a
7. A: But don't you think it might be useful kind of instrumental attitude requiring
to let it come out so that we can work ego functioning on the same, if not
with just that feeling? higher, level. By this, the pressure is
8. P: Yes, but at the same time it may give increased and A becomes emotionally
me a drawback. still more distant to P.
9. A: Drawback? No.4: P responds by almost openly express-
10. P: Yes, you are thinking: 'Oh my God, ing how the relationship to A is a
now she has been coming here all this matter of vital importance. Nothing
time, and still she shows-that's how else matters. It is as if P is sounding
far she has come!' the alarm.
11. A: You are still not sure that I can accept No.5: Still the signal is not received by A. By
you. insisting on the instrumental attitude
12. P: And the fact that you use the word (see No.3) he cuts himself off from
'invitation '. You were using that last catching the almost desperate under-
session too-that' I am inviting you' lying cry of P: 'If you leave me-
to something. In the first place I do everything is gone!'
not understand what an invitation is No.6: P has not resigned herself. Still she
-you see? I don't look upon it as an tries to break through with her mes-
invitation. To me it is a provocation sage: 'You mustn't leave me!' How-
and an attack-while you have meant ever, the word' but' indicates that the
it in a totally different way---eheck- desperation has acquired a more
mate! aggressive flavour. Eventually, this
13. A: Yes, I understand. That's how you may threaten the ultimate therapeutic
have experienced me. alliance.
No.7: In reply, A also adopts the word
Annotation :3 'but'. This mediates an argumentative
No.1: In using the word 'invite', A pre- attitude which adds an aggressive and
supposes that P is motivated to find guilt-producing element to the situa-
out something. He also takes it for tion. Certainly, the relation between A
granted that P has both the capacity and P is no longer one of co-operation,
and the will to endure displeasure for but one of confrontation.
the benefit of a postponed and higher No.8: In her reply, P chooses a rather special
order goal. This implies ego func- term, 'drawback'. At face value this
tioning on a complex level of or- sounds somewhat unprecise. Dy-
ganization. namically, however, this very lack of
No.2: P's answer reflects no effective work- precision may be a point of import-
ing alliance indicating that the ego is ance. It is likely that it serves as a
not functioning at the expected level. cover for a more serious danger-
Thus, what is intended as a bargain on possibly that of suicide---even if this is
behalf of A, is experienced by P as an not conscious to P. 4
act of maliciousness. This would be a No.9: Obviously the metacommunication

3 Only aspects of the material relevant to the conflict/ 4 This hypothesis is not justified only on the basis of the

deficit discussion will be commented on. Problems of resist- present material. However, compared with previous material
ance and countertransference which also appear in the it appears likely.
material, will be deleted.
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72 BJ0RN KILLINGMO
mediated through the word 'draw- The invitation to search for meaning implies
back' puzzles A and makes him an attitude of continuous, goal-directed mental
change the level of intervention. He effort. However, for the person of deficit such an
now abstains from urging P to co- attitude has no appeal. It is not experienced as
operate further and restricts himself to an exciting, stimulating or even a dangerous
posing a simple question. venture. Basically, it is experienced as an im-
No. 10: In answer, P openly expresses her fear poverishing burden which one is compelled to
of being abandoned by A. carry, or a lip service which has to be paid, while
No. 11: Even if the word still may com- waiting desperately for the real thing to come. In
municate a certain reproach on behalf metaphorical terms, the person of deficit is
of A, P's message seems to have come always waiting for Godot. At the same time it
through. A now realizes the acute should be emphasized, when speaking of the
need of P to have her immediate 'patient of deficit', that this does not refer to the
feelings confirmed. This is obliged by personality as a whole, only to that part of the
A simply stating how P is experiencing psychological make-up which derives from
the situation. Thereby, he conveys an deficit. Not even on a hypothetical level would it
understanding and acceptance of be reasonable to conceive of an individual totally
what it is like to be P. without conflict.
No. 12: The more wordy passage following We have now arrived at the third question
indicates that the affirmative flavour posed in the introduction to this paper. By what
of A's intervention has decreased the cues can the analyst decide whether the clinical
tension level of P. She is now able to material at hand is based primarily on deficit or
take some distance from her needs and conflict? In the preceding discussion it was
thus give a more coherent account of asserted that the quality of the transference may
how she is experiencing her relation- be helpful for the analyst in identifying the
ship to A. This would be a demon- structural level involved. Speaking in these
stration of how affirmation may im- terms, we may say that A in the above illustration
prove ego functioning. missed certain cues which might have told him
No. 13: A is now fully aware of the structural that he was facing not a conflict transference,
mismatch. Accordingly, he has but one of deficit.
changed his intervention from one of Going back to the dialogue, what significant
unveiling of meaning to one of con- cues can be extracted from the way the patient
stitution of meaning. He is once again relates to the analyst? First of all, there is a
emotionally available to P. quality of monotonous persistence in the
In this excerpt we have witnessed an analyst patient's way of demanding. She neither varies
intervening on a level too high for the current the theme nor does she make delicate distinctions
structural ability of the patient. The analyst emotionally or cognitively. It is like playing a
presupposes the patient to be allied in a shared simple melody on an instrument with few strings.
attitude of 'finding out'. What he does not Probably, this is a reflection of a deeper quality
realize is that the actual material primarily of objectlessness pervading sectors of mental life
derives from deficit, not from conflict. Accord- originating in deficit. The variety of affects and
ingly, the patient has no motive whatsoever colourful fantasies which accompany a fully
for finding out anything. Such an attitude has no developed object-orientation is lacking.
psychic reality to her. Her motivation operates Secondly, there is a special quality of directness
on a more undifferentiated level. She is in need both in style and in choice of words. It is the
of experiencing a quality of being. This need 'frankness' of the person who has nothing to
constitutes the emotional centre at the moment. hide and therefore in an obstinate way can press
We can describe the relationship between P and his point without risking the burden of evidence
A by a metaphor: P is knocking on the gate of being turned back on himself. This attitude is
A's house, while A opens the window on the likely to be a reflection ofthe absence of primary
second floor. So he does not let the patient in. intentionality in deficit-pathology. It has its
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CONFLICT AND DEFICIT 73

origin in a basic feeling of being unjustly treated, it should be worded more in accordance with the
not by specific objects in a mutual relation of 'emotional dialect' of the patient in order to
love and hate-but by the impersonal impact of function clinically. On the level of principle,
reality. however, this type of intervention illustrates
Thirdly, the emotional flavour is one of some aspects relevant to affirmation:
oscillation between desperate hope and resig- (1) Objectifying. By conveying an experiental
nation, leaving no room for a moderate position quality of 'I can feel what it is like to be
in between. Both the lability itself and the you', A contributes to making the feeling
extreme quality of the affects suggest that it is a state ofP less private. It becomes something
matter of vital importance. Probably, what we that has shape, can be shared with an other
see is a reflection of an underlying anticipation and eventually be put into words.
of catastrophe connected with fragmentation of (2) Justifying. By introducing a cause-and-
the self structure. effect relation, the feeling-state is under-
Finally, we should note that the patient herself stood in a context of reasonable natural
uses words such as 'insecurity' and 'attack' in events. Thereby, both confusion and the
describing her relationship to the analyst, words burden of secondary guilt will be dim-
indicating a person who is more a victim of an inished.
assault than a participant in a plot. To be sure, (3) Accepting. By including the historical con-
a patient of conflict may also describe the text, A gives the terms for his under-
relationship to his analyst in negative terms, but standing. This will convey to P a more
at the same time there is a quality of shared reliable impression of a person who really
responsibility. Unconsciously, the patient of understands. By addressing his under-
conflict knows that he himself has contributed standing to the infantile level, A also makes
to the plot by putting in claims which are it easier for P to accept the analyst's accep-
primarily his own. Therefore, in advancing tance of her, in spite of guilt and deceit
criticism, he will take measures so that his own which otherwise may colour her current
contribution is not activated or disclosed. Ac- self-image.
cordingly, he will exert a subtle control displayed The aim of affirmative interventions, like the
by indirectness, diplomacy, vagueness and one exemplified, is threefold: (1) to restore the
underhandedness in his relating to the analyst. emotional availability of the analyst, (2) to
The patient of deficit, however, feeling no such create an emotional optimum so that the
obligation, may without further ado take the empathic failures of the analyst may function as
plain position of a victim. motivation for internalization, (3) to reduce the
Assuming that A in the above illustration had compulsive dependence on the analyst's ap-
taken the hint at an earlier moment, what would proval. Hopefully, this may turn the orientation
have been an appropriate intervention? The of the patient from one of demanding, to one of
optimal point seems to be after No.2. Obviously, examining the demandingness itself. That is, by
here P is feeling not only rejected but also deeply having the immediate need for meaningfulness
insecure, and she is in almost desperate need for complied with, the ego will be able to raise its
a confirmation of her state of feeling. At the level of functioning and to adopt an investigating
same time the aggression has not yet been attitude-at least for a while.
completely mobilized. A possible intervention The emphasis on deficit pathology in recent
could go like this: 'Yes, you have good reasons years may have led to an accentuating of
to feel insecure when I don't answer you. It is affirmative techniques at the expense of inter-
just like what you were feeling when mother pretation of active intentionality. By over-
didn't answer you when you were a little girl and stressing the affirmative aspect, structural
you desperately needed to know what she really complexity may easily be overlooked. First, as
thought of you. And now you feel that I am just has already been underlined, in the grown-up
like her and that I will leave you'. Of course, we personality, derivatives of deficit and conflict,
cannot be sure that this intervention, constructed respectively, are indissolubly organized together
in retrospect, would have been optimal. Maybe in complex patterns of character. Secondly, even
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74 BJ0RN KILLINGMO

Qinica1
.
Conflict -
Revealing
meaning - Interpretive
. .
mtervenuons

material
.... - - - - - - - - Structural turning point

Defi . Establishing _ .Mfmnat~ve

en - meaning uuervennons

if a pathological pattern of character is primarily demandingness also has an element of aggressive

based not on conflict but on structural injury demonstration of the analyst's inability to help
inflicted by the environment, it is the subject's her. Unconsciously, he is identified with the
interpretation of the injury we address in therapy. mother. Thus, by bringing the therapy to failure,
The psychic reality of the happening is the the patient can triumphantly receive her revenge
patient's own construction. Thus, even where on the mother. It would have been a serious
the component of deficit dominates the patho- failure if this aggressive resistance had not been
logical make-up and accordingly an affirm- demonstrated and interpreted to her.
ative quality has to be built into most of the The clinical implications of the discussion so
interventions, this will not be sufficient. Also far may be summarized by way of the illustration
analytic interventions will be needed to unveil above.
resistances and to explore the fantasies in terms By passing through the 'conceptual lens' of
of which the patient has reinterpreted reality. As conflict/deficit-transference, the clinical material
is stated by Langs: 'In recognizing the realities is spread in two directions. As long as the
of the early traumas (Khan, 1963) suffered by material points mainly in the direction of con-
these patients, one must not overlook their flict, the strategy of choice is that of revealing
fantasied and distorted components of the sub- meaning through interventions ofan interpretive
sequent reworking and reinterpreting of these type. When material points in the direction of
earlier experiences, in which unconscious fan- deficit, the strategy will be one of establishing
tasies and introjects play an important role' meaning through interventions of an affirmative
(1976, p. 113). Thirdly, the infantile deprivation type. In each patient we may speak ofa structural
will not remain as an uncomplicated condition turning point (see fi.gure). That is where conflict
of shortage, waiting for 'refill '. Disappointment, transference fades away and deficit transference
rage and vindictiveness will lead to a change in takes over. Passing that point, the investigative
the needs themselves. They will be structured as attitude no longer matches the structural level of
ambivalent needs characterized by the person the patient and the analyst has to change his
being at the same time both willing and not strategy. If not, his intervention is likely to act as
willing to accept what is offered him. an assault against the self-representation of the
The above mentioned properties of de- patient. This is amply illustrated in the clinical
velopment represent structural resistances pre- illustration above. P's last remark (No. J2)
venting direct access to the original state of demonstrates in plain words that the adoption
deficit. The only way to modify the infantile of an investigative attitude, which may be ex-
state, be it ultimately based on deficit or on perienced by other patients as an invitation, is
conflict, is through analysis of the structural perceived by P as an attack. P is functioning
transformations of the original traumas. Beside below the structural turning point, so to speak.
these structural resistances, there are dynamic It should also be remembered that the quality
resistances as well. In the case illustrated above, of the transference may be close to the structural
a desperate claim for recognition from the ana- turning point and so is apt to change rapidly.
lyst arising from empathic failure of the mother, Accordingly, the analyst should be in a state of
was predominant. However, there is more to constant receptivity for oscillation between the
it than this state of deprivation and cry for two strategic positions. Often, an emotional
'fill-up'. The insisting quality of the patient's cluster has initially to be interpreted on a con-
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CONFLICT AND DEFICIT 75

f1ictual basis. Next, elements of the same cluster theory may leave a certain doubt concerning
have to be affirmatively responded to until, at precisely the quality of the analyst's attitude.
last, the pattern as a whole is again interpreted Especially Kohut's (1984) latest theoretical for-
as an expression of conflict. This oscillation in mulations stating that all pathology has to be
strategy reflects the close interaction and conceptualized in terms ofdeficient self-structure
hierarchical structuring of material derived from and that even the grown-up mature person is
conflict and deficit respectively. dependent on continuing empathic response
The necessity of oscillation in therapeutic from selfobjects, may give the impression that
strategy described above, is founded on theor- the analyst also has to act as a selfobject to the
etical elaborations of relatively recent date. patient. That is, the analyst takes the role as a
How were these problems handled before the provider of something the patient has not got-
new conceptual distinctions were available? or not got enough of-from the original
There is good reason to believe that many selfobjects, be it love, approval or empathy.
analyses have been carried out on a structural Although Kohut himself seems to be of the
level out of match with the level where the opinion that interpretation is the main technical
central emotions of the patient have been or- means also concerning deficit pathology, that is
ganized. The two analyses of Mr Z (Kohut, 1979) in correcting and repairing deficient self-
pose this problem. Going structurally too high, structure, his general psychological outlook
affects based on deficit may not have been seems, by implication, to clear the way for a
caught up by the analytic process. Instead, they 'supply' orientation. Obviously, such an orien-
have remained unchanged, and even more iso- tation is contrary to the traditional analytic
lated, constituting an undercurrent of chronic attitude.
unhappiness and disappointment. Partly, this To settle the problem concerning the analytic
may be due to a rigid adherence of the analyst to attitude, one has to make an assumption as to
the classical conception of conflict as the sole what quality in the therapeutic relationship is
principle of pathology. On the other hand, we decisive in promoting therapeutic progress. A
have reason to believe that analyses have been useful concept in this connexion seems to be that
successfully carried through even if there have of emotional availability (Bowlby, 1973). The
been obvious elements of deficit in the psycho- concept of availability of the analyst has been
logical make-up of the patients. The reason for referred to on several occasions in the preceding
this may be that good therapists, be they clas- discussion. Now it should be put in its proper
sical analysts or psychotherapists, have always place. By being emotionally available, a feeling
adapted their technique sensitively to the specific of not being isolated is mediated to the patient. It
deficit/conflict mixture of the individual patient is assumed that this experiential quality is a
even if this has not been theoretically articulated fundamental condition for any change to take
or even consciously realized. place. Thus, emotional availability is as im-
A last question remains: Will the above men- portant when working in the sphere of conflict
tioned extension of pathological understanding as when dealing with derivatives of deficit. The
and of therapeutic technique lead to disregard analyst has always to be available in order for
or at least a modification of the traditional the therapy to progress. However, the relational
analytic attitude? Will the analyst, as he changes quality making the analyst available at the level
his strategy, also have to change his emotional of conflict does not necessarily make him
attitude towards the patient? Does the patient, available when the patient is functioning on the
when deficit-based material is activated, need level of deficit, as was demonstrated in the
emotional support in addition to the holding- clinical illustration above. Therefore, by careful
aspects already included in the analytic attitude empathic listening, the analyst has to grasp
(Modell, 1976)? Has the analyst to adopt a those specific qualities of object relations re-
'warmer', 'closer', more 'empathic' way of flected in the transference, and to adjust his
relating to the patient? interventions accordingly.
Why is it relevant to raise these questions? Taking the principle of emotional availability
The ongoing discussion and revision of classical as the starting point, the question is: What
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76 BJ0RN KILLINGMO
makes the analyst available at the levelof deficit? available, and the process may then proceed by
Is an extra amount of love, care or approval the patient expressing his loss and his hatred and
necessary? In my opinion the answer is not by successivelyexploring how he has blocked his
along the line of further supply. Trying to own feelings and cut himself off from close
become available by satisfying the patient's contact. At the same time, this very manner of
needs seems to rest on the assumption that it is handling the selfobject transference can be con-
possible to obtain direct access to infantile needs ceptualized as a mature selfobject representa-
in the adult. For reasons mentioned earlier in tion. Thus, the analyst acts both as a transference
this paper, this is an untenable assumption. It seifobject and as a new seifobject, the latter
fails to take into account the complex structural stimulating structure building. The experience
transformations which fixated infantile needs of this mature selfobject, in contrast with the
and object relations have undergone during the previous infantile selfobjects, prepares the
succeeding development. In the patient referred ground for the patient's taking over self-
to above it might have caused serious com- regulating functions in instances of the analyst's
plications if the analyst had answered her claims 'optimally failing empathy' (Kohut, 1977).
for approval by really offering her a positive However, whether this transmuting internal-
evaluation. First, due to a strong feeling of guilt ization differs on the level of principle from
it would not have been acceptable for her on a internalization taking place in classical analysis,
deeper level to receive such a gift. Unconsciously, remains to be clarified. Generally speaking, in
the feeling of guilt would have increased. both instances the analyst serves as model for
Secondly, receiving a gift would have been most learning more differentiated ego-attitudes.
threatening for this woman because her whole Thus, so far, no change in the analytic attitude
identity is built up around the conception of is indicated. The elements of objectivity,
being 'the not recognized one'. It is this 'story' patience, stability and tolerance-al1 embedded
the patient wants the analyst to confirm at the in the analytic attitude-seem to be as productive
present, not to be given the recognition of the in dealing with derivatives of deficit as they are
original selfobjects. Thus, by giving approval in the sphere of conflict. No special or extra
instead of commenting on the patient's panic at quality of emotional participation is necessary.
being in a receiving position, the analyst would However, one distinctive feature of the analytic
in fact become emotionally more distant to the attitude is the focus on finding out (Schafer,
patient. 1983). According to the way of reasoning out-
The 'therapist of supply' seems to fail to lined in the present paper, this very focus has
distinguish clearly between being a selfobject little or no psychic reality to patients in con-
and being in transference as a selfobject. The texts of deficit. As far as this element goes, a
empathic quality of the therapeutic encounter modification of the analytic attitude has
activates transference of fixated selfobject ex- obviously to be undertaken. However, exemp-
periences in the patient. However, the analyst tion from the investigating element is not the
does not respond to these by moving into the same as disregarding the analytic attitude
supplying position of the infantile selfobject. altogether. The analytic attitude is a complex
What he does is to confirm the patient's need cognitive and emotional way of relating, made
for-and right to-being confirmed. That is, he up of several elements among which is also an
gives his empathic understanding of how it must affirmative one (Schafer, 1983). Thus, both the
be not to have received the wished-for recog- investigative and the affirmative mode are in
nition when it was most needed and rightly to be principle included in the analytic attitude and
expected, thereby justifying that the patient feels have to be given priority alternatively. Is there a
as he does. By confirming exactly the way the common denominator underlying both modes
patient is feeling, the analyst relates to the most which can be said to form a more basic element
urgent need of the patient of deficit, that is the of the analytic attitude? In my opinion such a
need to feel that' I am' and that' I have the right common element exists and can be formulated
to be'. By mediating this very quality of ex- as the principle of letting the patient be. This is
perience, the analyst can become emotionally not to be misconceived as emotional neutrality.
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CONFLICT AND DEFICIT 77

On the contrary, it conveys a profound respect keynote of sympathy. The position taken here is
for the patient's right to gain experience on his that the oscillation between an interpretive and
own premises and a confidence in his ability to an affirmative strategy can take place within the
do so if given the opportunity. This quality of analytic attitude by alternatively focusing on
freedom, which should never be exempted from different part elements of the attitudinal cluster.
therapy, is perhaps the best support the analyst No change in basic attitude seems necessary
can give the patient on his road to autonomy. either theoretically or clinically.
Finally, what about the concept of psycho-
analytic neutrality? Is the analyst to disregard
this time-honoured element of the analytic atti- SUMMARY
tude? None of the analytic principles seem to
have been more misunderstood or distortedly One of the most challenging theoretical tasks
construed by critics of psychoanalysis than the today is to integrate the psychology of deficit
principle of neutrality laid down by Freud in his with the traditional psychoanalytic conception
technical recommendations (1912). First of all, of conflict. In this paper it is argued that such
it should be stated that neutrality is but one an integration should take place within a
aspect of the analytic attitude. Next, neutrality framework of structural organization. By means
does not exclude the human quality of sympathy of the quality of the transference, the analyst has
as a basic tone pervading the whole project of to decide whether an actual piece of clinical
psychoanalysis. Finally, neutrality has to be material is mainly to be seen as an expression of
conceived of as a principle for handling the conflict or of deficit. The paper illustrates how
transference and not as a description of the derivatives of deficit may appear in the thera-
actual emotional behaviour of the analyst. peutic dialogue. When these are about to
Recently, Hoffer (1985) has put forward a dominate, the analyst has to switch his strategy
view of neutrality which seems to coincide well from one of unveiling meaning to one of consti-
with the line of reasoning in the present paper. tution-utilizing inverventions of an affirmative
According to Hoffer, the primary goal of the type. As the structural level will fluctuate within
analyst is that of identifying, defining, and one and the same patient from one point of time
engaging the patient in relation to his conscious to another or from one area of the personality to
and unconscious conflicts. With this as his point another, the analyst has to be in a state of
of departure, neutrality is defined as the optimal constant receptivity to oscillate between the two
position from which the analyst can observe strategic positions. It is concluded that even if
specifiable conflicts. Thus, neutrality is not a psychoanalysis has to extend both its conception
description of general behaviour, but a way of of psychopathology and its therapeutic strategy,
identifying conflict. In fact, there is a connexion no change in the basic analytic attitude seems
between empathy and neutrality, understood necessary.
as the analyst's genuine appreciation of the
patient's dilemmas and conflicts from the
patient's point of view. So, the concepts of
neutrality and empathy are mutually reinforcing, TRANSLATrONS OF SUMMARY

not antithetical (p. 783). Hoffer also notes that L'une des taches theoriques les plus stimulantes
in the adult, the conflict is often experienced aujourd'hui consiste a integrer la psychologie du deficit ala
around efforts to hide the' deficit' or the feelings conception psychanalytique traditionnelle du conflit. Dans
cet article, l'auteur defend l'idee que cette integration devrait
of need which the patient associates with it se faire dans Ie cadre de l'organisation structurale. En
(p. 773). In the adult patient, therefore, struc- utilisant la qualite du transfert, I'analyste doit decider si un
tural deficit usually will appear clinically in fragment reel de materiel c1inique doit etre essentiellement
considere comme I'expression d'un conflit ou d'un deficit.
contexts of conflict and accordingly has to be L'auteur montre comment des derives du deficit peuvent
approached initially by analytic means. apparaitre dans Ie dialogue therapeutique. Lorsque ceux-ci
To sum up: The analytic attitude is a complex sont sur Ie point de predominer, l'analyste doit changer de
strategic et passer d'une strategie visant a devoiler Ie sens a
cognitive/emotional way of relating, com- une strategie visant a constituer Ie sens utilisant des inter-
pounded of several elements, all converging in a ventions de type affirmatif. Comme Ie niveau structure! va
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78 BJ0RN KILLINGMO
fluctuer chez un meme patient d'un instant al'autre ou d'un Aufnahmefahigkeit befinden, urn zwischen den beiden
a
secteur de la personnalite l'autre, l'analyste doit etre dans strategischen Positionen zu wechseln. AbschlieBend wird
un etat de receptivite permanente pour osciller entre ces deux bemerkt, daB auch wenn immerhalb der Psychoanalyse
positions strategiques. L'auteur conclut que meme si la sowohl die Auffassung von Psychopathologie als auch
psychanalyse doit a la fois elargir sa conception de la die therapeutische Strategie ausgedehnt werden muB,
psychopatholgie et sa strategic therapeutique, aucun scheint eine Anderung an der grundlegenden analytischen
changement dans l'attitude analytique fondamentale ne Haltung nicht von Noten zu sein.
semble necessaire,
Una de las tareas teoricas mas desafiantes hoy en dia es
Eines der anregendsten theoretischen Aufgaben von heute integrar la psicologia de deficit con el concepto tradicional
besteht darin, die Psychologie des Defizits mit der tradi- psicoanalitico de conflicto. En este articulo se propone que
tionellen psychoanalytischen Auffassung iiber den Konflikt esta integracion deberia tener lugar dentro de un marco de
zu integrieren. In der vorliegenden Arbeit wird argumentiert, organizacion estructural. Juzgando la calidad de la trans-
daB eine solche Integration im Rahmen von struktureller ferencia el analista tiene que decidir si un determinado
Organisation stattfinden sollte. Der Analytiker muB unter material clinico se ha de considerar principalmente como
Beriicksichtigung der Qualitat der Ubertragung entscheiden, expresion de conflicto 0 de deficit. EI articulo ilustra el modo
ob ein vorliegendes Stiick von klinischem Material haupt- en que derivados de deficit aparecen en el dialogo terapeutico,
sachlich als Ausdruck eines Konfliktes oder eines Defizits Cuando estos parecen dominar, el analista tiene que cambiar
beurteilt werden muB. Es wird erlautert, wie Defizitderivate su estrategia, y en lugar de desvelar significado, debe
im therapeutischen Dialog erscheinen konnen, Wenn diese constituirlo, utilizando para ello intervenciones de tipo
beginnen das Bild zu beherrschen, dann muB der Analytiker afirmativo. Dado que el nivel estructural fluctua en el mismo
seine Vorgehensweise umstellen und YOm Aufdecken von paciente de un tiempo a otro y de un area de la personalidad
Bedeutung zum Herstellen von Bedeutung iibergehen, a otra, el analista tiene que estar en con stante estado
indem er Interventionen von affirmativer Art benutzt. Da de receptividad para oscilar entre esas dos posiciones
innerhalb ein und desselben Patienten das strukturelle estrategicas, El autor concluye que incluso si el psicoanalisis
Niveau zu verschiedenen Zeitpunkten oder zwischen tiene que extender tanto su concepto de psicopatologia como
verschiedenen Personlichkeitsbereichen schwanken wird, su estrategia terapeutica, no parece necesario hacer cambios
muB der Analytiker sich im Zustand dauernder en la actitud analitica basica,

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Bjarn Killingmo Copyright © Institute of Psycho-Analysis, London, 1989

Psychological Clinic I
Psychological Institute, University of Oslo
Box 1094, Blindern
0317 Oslo 3
Norway
(MS. received December 1986)
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