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Non Interpretative Measures in The

Non Interpretative Measures in The

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NONINTERPRETATIVE MEASURES IN THEANALYSIS OF TRAUMA
Arnold Wm. Rachman, PhD, Margaret A. Yard, PhD,and Robert E. Kennedy, PhD
The Institute of the Postgraduate Psychoanalytic Society
Psychoanalysis has a long and distinguished history in the use of non-interpretative measures, first introduced by Freud in the case of the Rat Manand, then, formalized in the case of the Wolf Man. Freud passed the mantle toFerenczi when he declared the future development in psychoanalysis wouldcenter around Ferenczi’s introduction of the role of activity in psychoanalytictechnique. Over the course of his clinical career Ferenczi described a theory of trauma, the Confusion of Tongues paradigm and experimented with RelaxationTherapy which included a wide array of non-interpretative measures in order tosuccessfully treat trauma. Three clinical cases are presented by the authors toillustrate the use of on-interpretative measures in the contemporary analysis of trauma. Trauma creates a developmental freeze which interferes with the indi-vidual’s capacity to mentalize, i.e. create representations which can be stored inlanguage and thus, symbolize concepts for meaning formation. Arrested devel-opment of cognition and verbal interaction is stored in the body as a somaticmemory. Non-interpretative measures are an effort to reach the split-off pre-cognitive and somatic aspects of the trauma.
Keywords:
non-interpretation measures, analysis of trauma, Ferenczi, role of activity
Freud’s Introduction of Noninterpretative Measures
There is a significant history in psychoanalysis for the use of noninterpretative measuresto aid the expression of suppressed affect, as well as to aid the working through process.Although Freud is considered to be the prototype of “the analyst as interpreter,” it isseldom recognized that the founder of psychoanalysis pioneered the employment of noninterpretative measures. Freud’s original introduction of noninterpretative measurebegan with feeding the Rat Man (Coltrera & Ross, 1967). After much discussion feeding
Arnold Wm. Rachman, PhD, Margaret A. Yard, PhD, and Robert E. Kennedy, PhD, The Instituteof the Postgraduate Society.Correspondence concerning this article should be addressed to Arnold Wm. Rachman, PhD,8777 Collins Avenue, #210, Surfside, FL 33154. E-mail: nancy.rachman@nick.com
Psychoanalytic Psychology © 2009 American Psychological Association2009, Vol. 26, No. 3, 259273 0736-9735/09/$12.00 DOI: 10.1037/a0016448
259
 
the Rat Man was attributed to Freud’s humanism (Boyer & Giovaccini, 1967). In hispioneering case of the Wolf Man, however, Freud formally introduced four noninterpre-tative measures: (1) a cure was promised; (2) the patient was treated without a fee; (3)money was raised for the treatment; and (4) a termination date was set (Freud, 1918/1955).It was Freud’s clinical acumen that moved him to deviate from his own standardprocedure (Roazen, 1975). The analysis of The Wolf Man could not be conducted, Freudbelieved, by only the use of his standard technique. His idea was to match the analysand’sdevelopmental and real-life needs with meaningful therapeutic procedures. Although itcannot be said that the noninterpretative measures provided a cure for the Wolf Man, it didelasticize the concept of psychoanalytic treatment. Freud’s influence continued after hisdeath, when a series of analysts would journey to Germany during the summer months, tocontinue to treat The Wolf Man without a fee (Roazen, 1975).
Ferenczi’s Elasticity Principle
Freud believed the treatment of difficult cases where childhood trauma was evident wasthe future of psychoanalysis (Freud, 1919 [1918]/1958). While Freud turned his attentionto the further development of theory, he entrusted the evolution of analytic method toFerenczi (Rachman, 1997, 2003a). Ferenczi devoted his career to the study of trauma andthe elasticizing of the boundaries of the analytic method (Rachman, 1997, 2003a, 2007).In a series of groundbreaking papers, Ferenczi described the expansion of the analyticmethod to include a wide array of noninterpretative measures (Ferenczi, 1980a–1980l,1988). These were measures that allowed the analysts to create a variety of clinicalinteractions other than the tradition of interpretation, such as active roles for the analystand the analysand; cocreated clinical interventions; clinical empathy; countertransferenceanalysis; analyst self-disclosure; and mutual analysis (Rachman, 1997, 1998, 2003a, 2004,2007). The most extensive description of an analysis where noninterpretative measureswere used was Ferenczi’s case of Elizabeth Severn, (R.N. in
The Clinical Diary
[Ferenczi,1988]). Ferenczi conducted his analysis with Severn to deal with severe and persistentchildhood trauma (Balint, 1968; Ferenczi, 1988; Rachman, 1997, 1998, 2003a, 2007).Both Eissler’s idea of “parameters” (Eissler, 1953) and Stone’s concept of “wideningthe scope” (Stone, 1954) brought the idea of noninterpretative measure into the domain of traditional psychoanalysis. In the ensuing years since the Eissler and Stone publications,noninterpretative measures have been explored, reformulated, extended, and integratedinto the object relations: interpersonal/humanistic, self-psychology, and relational per-spectives (Rachman, 2003a). The British Object Relations perspective, most notablyBalint (1968) and Winnicott (1965), integrated an active role for the analyst when“working to the zone of regression” with severe neurotic, borderline, or psychoticdisorders. Balint was a witness to Ferenczi’s extensive use of noninterpretativemeasures in the analysis of Elizabeth Severn (Balint, 1968). In fact, one could say thatFerenczi’s case report about Severn was the first attempt to formally use noninter-pretative measures to aid in the analysis of trauma (Rachman, 2009). Margaret Littlereported on her analysis with Winnicott and his use of noninterpretative measures(Little, 1981). Self-psychologists, most notably, Bacal (1990) and Estelle and MortonShane (Shane & Shane, 1996), have attempted to expand the traditional Kohutian modelto include noninterpretative measures. Both Bacal and Morton Shane were students of Balint. Bacal also has integrated object relations ideas into his self-psychology perspective(Bacal & Newman, 1990).
260 RACHMAN, YARD, AND KENNEDY
 
Three Cases of the Use of Noninterpretative Measures in theAnalysis of Trauma
Three clinical examples will illustrate the contemporary use of a relational perspectiveinformed by Ferenczi and Balint’s ideas (Rachman, 2003a, 2003b, 2007), where nonin-terpretative measures were employed in the analysis of trauma (Rachman, 2003a, 2004,2007, 2009). These examples are Margaret Yard’s “Case of Denise,” Robert Kennedy’s“Case of Patrick,” and Arnold Rachman’s “Case of Winston.” These cases illustrateelasticizing the boundaries of analytic work to reexperience and work through childhoodtraumas unreachable by conventional verbal interaction and interpretation. Noninterpre-tative measures are seen as a meaningful, and at times necessary, adjuncts to the analysisof trauma (Rachman, 2004, 2009; Rachman, Kennedy, & Yard, 2005; Rachman, Kennedy,& Yard, 2009).Noninterpretative measures should not be viewed as nonanalytic. In the relationalperspective, especially the view that integrates Ferenczi and Balint’s ideas (Rachman,1997, 2003b, 2009), the use of activity that goes beyond traditional clinical boundaries isa necessary step toward freeing up associations so that the analysis can reach “rock bottom” (Ferenczi, 1980l) and work through the “basic faultof the origin of personalitytrauma (Balint, 1968). It is the contention of the authors that noninterpretative measuresmay be a necessary and sufficient condition for analyzing trauma. As we have discussed,Ferenczi profoundly understood this idea based on his commitment to Freud’s analytictheory and his own clinical acumen. What is more he had the personal courage to cocreateclinical encounters.It is clear to any clinician who regularly participates in clinical work with “difficultcases,” where trauma is at the heart of the difficulty, that flexibility, responsiveness, andcreative clinical encounters naturally evolve in a mutually democratic therapeutic process.
The Case of Denise: (Margaret Yard)
Denise, a 38-year-old grammar school teacher, with a long history of parental rejection,sought therapy because of a history of lost jobs. Denise had a history of conflict withsupervisors in her teaching positions. She had difficulty accepting direction and wasconfrontational with supervisors and teachers. She shared a lack of impulse control andgrandiosity. She wound up being escorted out of schools.She came to treatment in hope of keeping her new teaching assignment in a smallchurch-run school. Denise obtained this new job by plagiarizing a referral from a collegefriend, rewriting her resume, and editing out her previous job failures. Despite herelaborate attempts at being hired, Denise continued to jeopardize herself, by showing uplate. Ironically, she took her students’ occasional lateness as a personal affront, with noawareness that she had herself modeled the boundary-breaking behaviors.She developed creative lesson plans, but soon procrastinated, lost interest, and haddifficulty executing her detailed and expert class plans. Some perceptive students sensedher problem with boundaries, experienced her erratic and unpredictable behavior, herexcitability, and began to take advantage of her by purposefully challenging her. Psy-chodynamically, they mimicked the humiliation Denise felt at home when her mother hadtaunted her. Denise thrived on and created the tension of a chaotic and destructiveenvironment. Doing this, she reenacted the malevolent and unsafe atmosphere of her earlyhome.Severely traumatized by her strict, authoritarian mother who was inconsistent, inad-
261NONINTERPRETATIVE MEASURES IN THE ANALYSIS OF TRAUMA

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