Scandinavian Journal of Psychology, 1985, 26, 63-73

Problems in contemporary psychoanalytic theory:

II. Lines of advance
BJ0RN KILLINGMO
University of Oslo, Norway

Killingmo, B.: Problems in contemporary psychoanalytic theory. II. Lines of advance.

Scandinavian Journal of Psychology, 1985, 26, 63-73.
In the theoretical development to come in psychoanalysis, an "inclusive" strategy is
recommended, allowing for conflicting points of view to exist side by side waiting for a new
integrating theory to emerge. Until such a theory is at hand, the term "psychoanalysis"
will remain a rather loose heading for several psychoanalytic subcultures. It is argued, both
clinically and theoretically, in favour of giving the organizing function of the ego a central
position in the forthcoming theory. Some consequences of this "organizational" point of
view are discussed in relation to: (a) diagnostic classification, (b) the distinction between
psychoanalysis and psychoanalytically oriented psychotherapy, and (c) the theoretical
language of psychoanalysis. In conclusion som requirements for a future theory of psy­
choanalysis are proposed.
B. Killingmo, Psykologisk klinikk I, Psykologisk institutt, Universitetet i Oslo, Boks 1094,
Blindern, Oslo 3, Norway.

In a former article (Killingmo, 1985) some areas of theoretical conflict between traditional
drive theory on the one hand, and object relations theory, self theory, and ego theory, on
the other, are surveyed. It is argued that inconsistency and ambiguity seem so penetrating
that one can hardly speak of a unified theory of psychoanalysis at the present time. This is
especially due to conflicting points of view between traditional drive theory and object
relations theory concerning the nature of human motivation. The following questions were
raised: 1) Has time come for dethroning the concept of drives? 2) Should psychoanalysis
adopt a broad theory of motivation where drives are only one contribution among several
types of motivating forces?
To dispose of the concept of psychic energy (the economic point of view) and to allow
for motivational factors not derived from the drives, is a very radical undertaking. It is to
budge the very comer stones of traditional psychoanalysis-elements which are the most
"psychoanalytic" of psychoanalysis. We remember Fenichel's judgement passed on
Karen Homey's New ways in psychoanalysis: "A fundamental discovery of Freud's is
completely misunderstood (by Homey): the discovery that within the human mind there
are "ego-alien" forces which are not involved intentionally-even though unconsciously­
-for the purpose of avoiding something, but which, incomprehensible and strange, burst
in upon the personality like elemental catastrophes. They are in fact natural forces which
thus call attention to themselves, they are instincts which return from a state of repres­
sion" (1940, p. 117). Although it is not, in the present situation, a matter of rejection of the
concept of drives, as it was for Homey, it is easy to understand that some psychoanalytic
theorists refuse to revise the basic theory (Applegarth & Krent, 1978). Others take a more
flexible position. They realize the need for expansion of analytic theory yet do not want to
throw out the baby with the bathwater (Robbins, 1983).
In the theoretic development to come, one can choose between an "excluding" and an
"including" strategy. The first implies a restriction of psychoanalysis to a discipline based
on the central constructs of drives and energy, excluding all elements which are not
64 B. Killingmo Scand J Psycho! 26 (1985)

philosophically, theoretically and clinically consistent with these constructs. The second
strategy implies opening the way for points of view not consistent with drive theory and
living with unsolved theoretic conflict while waiting for a new integrating theory to emerge
sooner or later. Until such a theory emerges, the term "psychoanalysis" will remain a
rather loose heading for several psychoanalytic subcultures.
Obviously there are arguments for and against both strategies. Traditional drive psycho­
logy has the great advantage of being a unified theory. The reductionistic character of the
theory allows for adopting one and the same basic point of view towards all psychological
phenomena, normal as well as pathological. This will satisfy a need for "completeness"
and "final" psychological understanding. It also conveys a feeling of getting beneath the
surface of phenomena to the "true" needs or intentions (compare interpretation of dreams
and symbols). The concept of conflict, being part and parcel of the drive theory, provides a
context for polarizing psychological events. This consistently dualistic flavour of the
theory charges the concepts with tension and liveliness, which corresponds well to clinical
observations. Besides, clinical parts of the theory e.g. the sequence: Conflict-+ anxiety-+
defence-+ regression---+ symptom-formation, have proved their usefulness in the compre­
hension and treatment of the neuroses. Above all, 80 years of clinical experience has been
formulated and "stored" in the theoretical language of the drive theory. This alone is a
strong argument in favour of the excluding strategy.
As the monolithic position of the drives can be claimed to be the main strength of the
traditional theory, it can as well be claimed to be its main weakness. It prevents other
types of psychological needs from being included in the theory. Needs originating from the
dependency of the infant on the human object are not regarded as motivational forces in
their own right. However, clinical observation, as well as studies of infant development,
speak in favour of basic needs of non-libidinal origin and this ever increasing evidence
makes it almost impossible to maintain the exclusive position of the drives. Another
objection against the drive energy theory is its simplifying nature. The mechanical and
quantitative implication of metapsychology cannot grasp the qualitative shadings of intra­
personal experience and of interpersonal relations. Especially by limiting the whole area of
narcissism to derivatives of drives, an independent contribution of relational factors to
positive self-feeling is excluded. Conceptualizing all varieties of psychopathology in a
conflict/regression scheme is also disproved by clinical experience. Recent papers from
clinical practice with primitive or pre-neurotic structures indicate that arrest in develop­
ment rather than conflict is at the bottom of these pathological states, and that emotional
shortcomings rather than moral condemnation are the pathogenic contribution of the
environment (Robbins, 1983; Meyerson, 1981).
In my opinion, the arguments above are in favour of the inclusive strategy. To be able to
cover the widening scope of psychoanalytic observations, psychoanalysis has to develop
an inclusive concept of motivation. Needs from different sources must be allowed to
operate side by side or in combination. This also implies separation of the concept of
narcissism from the libido theory and a broader foundation for the psychology of se If.
Maybe the term "narcissism" should be repudiated because of its historical connections to
the concept of drives. This would also pave the way for a more independent position of
affective phenomena. Affect should be allowed its own developmental line and to play a
central part in motivation. Maybe all psychological motivation should, in the first place, be
seen as resulting from changes in feeling-states. This seems to be on a level with Sandler:
"The assumption is made that ultimately all meaning is developmentally and functionally
related to states of feeling, and that an experience which does not have some relation to a
feeling-state, has no psychological significance for the individual at all" (1978, p. 292).
Finally, for a new integrative psychoanalytic theory to come into existence, it seems
Scand J Psycho! 26 (I 985) Psychoanalytic theory: Lines of advancement 65

necessary to decrease the theoretical importance of self and object relations. They should
not be regarded as distinct theoretical perspectives, but should be subsumed under
existing theoretica l concepts, partly as aspects of ego development (representational
world) and partly as motivational forces ("wished-for" relations). With a broad concept of
motivation the image of psychoanalytic theory will change. The sharp dualistic flavour of
the theory will vanish and will be replaced by a complex.field of forces in different degrees
of opposition to each other.

CLINICAL CONSEQUENCES OF THE THEORETICAL CONTROVERSY

In the long run the theoretical controversy, which has been outlined previously (Kill­
ingmo, 1985) may have a valuable and constructive effect. After all, psychoanalysis may
prove to be not a rigid and closed system of theoretical assumption, but a set of ideas open
to change and expansion. This certainly is in the spirit of Freud: ''For these ideas are not
the foundation of the science upon which everything rests: that foundation is observation
alone. They are not at the bottom, but the top of the whole structure, and they can be
replaced and discarded without damaging it" (1914, p. 77).
But the situation may also be experienced as confusing especially by the practising
clinician. Where has the good old psychoanalysis gone? What is safe psychoanalytic
theory today? Will the traditional concepts and ways of understanding still do? Faced with
this state of theoretical stress, the therapist may be tempted to chose one of the four
theoretical positions as his own-neglecting the others. Thus, the drive therapist will
continue to organize his clinical understanding in terms of fixations, conflicts and regres­
sion along the psychosexual line. The object relations therapist will obtain his clinical
understanding by organizing data in terms of dependency and failures of separation/indivi­
duation. For the self therapist clinical material will become meaningful through the
conception of empathic failure of the self-object and the resulting damage in self realiza­
tion. The ego therapist will be inclined to grasp the material in terms of defences, adaptive
measures and structural organization. Each of these positions represents an interesting
perspective on the functioning of the human personality. But none of them cover the
whole of it. By adhering only the one, the perception of clinical material will be unduly
selective and important aspects may be missed. The understanding remains one-sided. I
will call this a regression from a more complex level of understanding to a simpler one.
Such a regressive choice of theoretical positions is likely to correspond to the tempera­
ment, character, and "Weltanschauung" of the therapist. Thus drive theory will appeal to
the "moralizing" therapist, object relations theory to the "loving" therapist, self theory to
the "optimistic" therapist, and ego theory to the "sceptical" therapist. Naturally uncon­
scious factors will always influence the theoretical and professional inclination of the
therapist. Nevertheless it is unfortunate to have a set of theories "ready-made" for
different temperamental types. The correction of personal idiosyncrasies, which could be
brought about by a more unified psychoanalytic theory, is missed.
What influence has the present state of theoretical controversy on therapeutic tech­
nique? It is beyond the scope of this paper to discuss how the individual therapist may
experience the situation, to what degree he becomes insecure and what measures he may
take to protect himself and his clinical work. Instead I shall concentrate on some conse­
quences more on the level of principle. Therapeutic technique cannot be formulated as a
fixed set of rules to be applied in specified situations. From a psychoanalytic point of view
the dynamics of the therapeutic relationship are too complex to be specified in such a way.
Instead the therapist has continually to amplify concrete interventions on the basis of
psychological understanding. That is, technique must be derived from theory. However, if

5-858511
66 B. Killingmo Scand J Psychol 26 (I 985)

the theory is vague, inconsistent, or in a state of dissolution, the therapeutic technique will
also in the end be loose, contradictory or unsystematic.
A conception of psychopathology in terms of drives, conflict and regression implies
causal factors coming from within. On the other hand, a conception of psychopathology in
terms of deprivation, empathic failure and developmental arrest tends to confine the
ultimate causal factors to the outside. The infant has not got enough of the right stuff at the
right time to build a secure human attachment and a stable and separate representation of
himself and others. Moreover, the drive/conflict theory implies a picture of man as an
active, responsible agent, while the failure/arrest theory portrays man more as a passive
victim. In their extremes, these two ways of understanding human development will lead
to radical differences in therapeutic goals, in what is considered the healing mechanism
and in the modelling of the role of the therapist. The drive/conflict theorist will formulate
the goal of the therapy in terms of strengthening the ego. This implies that conflict will
always exist. However, with a more differentiated ego structure, the individual will be
better equipped to face conflict and reality without resorting to repression or other
maladaptive defences. The mechanism of healing is considered to be the lifting of repres­
sion in the service of increased insight. By contrast, the failure/arrest theorist will
formulate the goal in terms of undoing or repairing of structural damage, so that arrested
development can proceed along the normal course. The mechanism of healing will be some
sort of corrective emotional experience.
In a way the therapist of drive theory is a senior colleague to the patient taking an
untiring, respecting and stimulating interest in the patient's heroic investigation of his own
forbidden intentions and feelings. The therapist of failure/arrest theory is more of a
provider of a good human relationship and thereby tends to be a representation in reality of
the longed-for infantile object. Thus, the split in present day psychoanalytic theory may
tend to split therapists into an analytic and a caretaking variant.
In my opinion both variants, in their extremes, are over-simplified. On a more complex
level of understanding both are "helpers". The analytic therapist provides "analytic aid"
(e.g. interpretation of resistance) when the patient's own analytic capacity fails. The
caretaking therapist provides confirmation and explanation when the patient's identity is
confused. These strategies need not be different in principle. They can be seen to refer to
different levels of structural organization. A patient may function on a level of undeve­
loped or regressed ego identity where he is unable to experience the therapist's interpreta­
tion of resistance as a "help". It may therefore be necessary to provide confirmation and
explanation before the structural capacity to profit from interpretation is developed. In
order to handle such technical variations and to treat the huge varieties of structural
pathology in a consistent and systematic way, the therapist needs a developmental theory.
This theory should integrate both the "inside" and the "outside" perspective, and the
organizing function of the ego should be in the centre of the theory. From such a theory
the therapist could derive interventions that arc optimal to the structural level of the
patient. In the section to follow I shall argue in favour of giving the organizing function of
the ego (differentiation and integration) a central position in the further advancement of
psychoanalytic theory. I shall call it the "organizational" point of view.

THE ORGANIZATIONAL POINT OF VIEW

The term "ego" can be defined as a coherent organization of processes modifying outer
and inner stimulation to provide optimal adaptive integration at a given moment in time.
Two different aspects of this definition can be emphasized. The first is ego as an
organization of functions. This is the way ego is defined when we speak of the three
Scand J Psycho! 26 (I 985) Psychoanalytic theory: Lines of advancement 67

structure systems: id, ego and superego. Ego refers to a special sector of the total
personality, a "definite organizational structure". The second is ego as an organizing
agent having a "centralizing synthetic function" (Kemberg, 1976, p. 37). It seems that
most definitions of ego put these ideas together: ego as a result of organization and ego as
an initiator of organization. Hartmann states: "The recognition of the synthetic function
(not exclusive of, but in addition to, other regulations) made the ego, which had always
been considered an organization, now also an organizer of the three systems of personal­
ity" (1964, p. 291).
However, this synthetic function mentioned by Hartmann seems to be more basic and
inclusive than other ego functions. It implies ongoing organization of all mental phenom­
ena. This property is confirmed not only by psychoanalytic observers (Nunberg, 1955;
Spitz, 1965; Weil, 1978), but also by observers in other fields of psychology (Benjamin,
1961; Fantz, 1966; Piaget, 1936 ; Sander, 1975). An organizing process seems to be
operating right from birth, before other functions are differentiated and organized in the
system we use to call the ego. Blanck & Blanck choose to re-define the concept of ego,
making it identical with the organizing process (1979, p. 18). In my opinion, the organizing
process should not be classified as an ego function. The term ego should be reserved for a
substructure of the tripartite model referring to an organization of specific functions, while
the synthetic or organizing function should be seen as an organismic process having
priority to all other functions. The point is that all mental activity is organized, irrespective
of how it otherwise may be classified as belonging to id, ego or superego. In the course of
development, the organizing process leads to structuralization,that is, the establishment of
hierarchies of relatively stable patterns of experience and action. These resulting struc­
tures can be studied and described in three frames of reference: (1) within each develop­
mental line, (2) within each part structure (id, ego and superego), (3) within the personality
as a whole.
Roughly, these may be seen as three levels of structuralization with organization taking
place on all levels at every moment of time. This means that if we are to understand the full
implication of a psychological phenomenon, it must be comprehended in all three ramifica­
tions.
The concept of "egostrength" has been used to convey an overall evaluation of
personality structure. However, as long as we have no base-line for measuring such
strength, the concept seems to be no more than a cliche. To be clinically meaningful it has
to be given a more restricted meaning, e.g. the ability to resist regression (Hartmann,
1964). To give an overall evaluation of personality, I shall propose the concept of
structural consistency. This consistency should not be thought of in terms of degrees, but
as patterns of organization. The concept of consistency is treated more fully in Killingmo
(1980) where also clinical illustrations are presented. As stated in an earlier section, drive
theory and object relations theory tend to conceptualize pathology differently: the former
emphasizing conflict, the latter empathic failure and developmental arrest. The organiza­
tional point of view may contribute to an integration of the two. Developmental arrest and
conflict should not be seen as competing principles of pathological development but as
varieties of disturbances in the organizing process. On a general level, all varieties of
psychopathology can be formulated in terms of deviant organization and inconsistent
structure formation.
The main argument in favour of the organizational point of view is that changes in
integration and hierarchical organization lead to qualitative changes in psychological
functioning. This means that the decisive factor as to prognosis and therapeutic accessibili­
ty is not the content of the frustrated needs or impulses, nor is it the point of time of
trauma or onset of conflict. The crucial matter is how development has managed to bypass
68 B. Killingmo Scand J Psychol 26 (1985)

the damage and how it has been organized in the proceeding structural development. That
is, damage may to a certain degree be compensated by later structural development. It is
lifted to a higher level of organization, so to speak. In principle this means that of two
persons with the same developmental injury, the one may come out significantly better
than the other, thanks to favourable structuralization. Certainly my point is not that
structuralization will undo traumas or psychological lesions, but that they may be integrat­
ed in a manageable-even creative-way. Besides constitutional factors, I think this is the
only explanation of the fact that some people with notoriously damaging early experiences
nevertheless may live an astonishingly rich life. To conclude: In understanding psycho­
pathology and how to handle it therapeutically, the assessment of organizational and
structural aspects of personality comes prior to content of self-representations, object
relations, and drive derivatives.

SOME CONSEQUENCES OF THE ORGANIZATIONAL POINT OF VIEW

In the foregoing, I have tried to show that the organizational point of view leads to a more
differentiated understanding of psychopathology. In the following I shall discuss in more
detail how this understanding will influence: (I) the use of diagnostic categories like
"borderline" and "narcissistic disorders"; (2) the distinction between psychoanalysis and
psychoanalytically oriented psychotherapy; and (3) the choice of theoretical language in
psychoanalysis.
I. Borderline and narcissistic disorders as diagnostic categories
Trauma or onset of conflict always occurs in a personality that is in a certain state of
development on the three levels of structural organization outlined above. Thus, the
specific stage reached within each developmental line, the internal structure of the ego and
the overall integration of id, ego, and superego will determine how the individual will cope
with the crisis. This means that the resulting pathological reaction will be highly individ­
ualized. Moreover, the pathological reaction will be organized in the further development
through defences, compensations, and attempts at reparation and mastery. The effect of
this after-organization is dependent both on constitutional givens and on the particular
support that can be obtained from the surroundings of the individual. This further contri­
butes to the highly specific nature of the resulting structural damage.
This individualizing outlook on pathology has a number of consequences for diagnosis
and prognosis. First of all it seems that classification of structural deficiencies into the
common and popular categories of borderline states and narcissistic disorders becomes
very dubious. In the literature, a few salient features are reported to separate these
categories both from each other and from psychosis on the one hand and from neurosis on
the other. The borderline is said to be distinguished by splitting of good and bad self and
other representations, projective identifications, structural fragmentation and identity
diffusion (Kemberg, 1975). The narcissistic disorders are characterized by an unresponded
to autonomous self which gives rise to an incoherent self structure and repeated needs for
confirmation of the self through mirroring and idealization (Kohut & Wolf, 1978). None of
these classifications take into consideration all of the developmental lines composing the
total personality and the varying degrees of fixations from the one to the other. Neither do
they allow for the infinite number of ways of compensations which make each individual a
unique structural system. As Blanck & Blanck put it: "... such a diagnostic statement
omits consideration of the balance of conflict-free functioning, adaptation, malformation
and how all of these have worked their way into overall organization" (1979, p. 25).
What we observe in clinical practice is that modes of experience as well as object
orientations of varying degrees of maturity can co-exist in one and the same person. Such
Scand J Psycho] 26 (1985) Psychoanalytic theory: Lines of advancement 69

unevenness in the ego-profile may vary in degree and manner from person to person. To
be able to cope with these observations the new "nosologists" have to allow for hybrids
like neurosis with borderline features, high level borderlines, low level borderlines and so
on. But this is already an admission of the limitations of the classificatory approach. The
puzzling thing is that, while recognizing the need for such qualifying words, Kernberg still
insists upon borderline states being a diagnostic entity. It is especially dangerous when
Kemberg speaks of "underlying borderline organization" (1975, p. 9). Such a qualifying
phrase seems to imply that essentially the person is a borderline and that the neurotic
surface is but a peripheral part of the personality. From an organizational point of view
this is highly misleading. Every part of the personality is of course equally essential, in that
each plays a part in an organized structure, be it as a motive, a defence or as an adaptive
strategy.
Instead of composing a diagnostic picture of the individual by adding such classificatory
phrases, one should aim at describing in most detail the specific structural inconsistency in
every single case as it is reflected in all three levels of organization. Such a descriptive
system is presented in Killingmo (1980). By this multidimensional and hierarchic descrip­
tion, clinical one-sidedness will be avoided. Every part component is given a more
balanced position in the total picture. Thus a narcissistic element, which we indeed find in
every case, will not be blown up and overshadow the whole picture. It is counterbalanced
by all other factors and will thereby occupy a more modest position. To be sure, in a given
person narcissistic inclinations may be so strong that they "stand out" in the clinical
picture. This however, does not make it into a diagnostic entity!
I think it is safe to conclude that the new nosology is no better than the old Kriipelinian
one. In spite of new names the same sort of categorical thinking prevails. For some
statistical purposes (health registers etc.) and as a form of shorthand communication such
categories may have a limited practical value. Beyond this, however, they hamper further
theoretical development by sustaining entities which are either overinclusive or in a
narrower sense do not exist. They also give a false perspective in relation to treatment, in
maintaining the idea that there exists one technique of treatment for borderlines, one for
narcissistic disorders, and one for neurosis. From an organizational point of view there
exist only general principles of therapy based on developmental personality theory. These
principles must be varied and carefully adapted to the specific structural profile which is at
hand at any particular moment.
By implication, these new diagnostic categories also contribute to the idea that neurotic
conditions have the most favourable prognosis as to treatment, followed by the narcissistic
disorder in a middle position, with the borderline as the most unfavourable group.
Certainly this is not confirmed by clinical experience. It is well known that a structure
judged as a "pure" neurotic character can be very resistant to treatment, while a socalled
borderline structure can respond very favourably to treatment. The conclusion is that the
decisive prognostic factors as to treatment are not to be found in the patient's adherence to
a diagnostic group, but in the individual structural make-up.
By putting the organizing process in the centre of the theory and by replacing diagnostic
categories with descriptions of individual personality structure, the importance of symp­
toms is diminished as well. Two patients may have a certain compulsive ritual in common
but this does not indicate common pathology at a structural level. Treatment may reveal
that for the one the ritual is a circumscribed defence to undo an aggressive impulse in an
otherwise well-organized structure. In the other, we find that the ritual is an all or nothing
defence, rigidly maintaining identity against the onslaught of anxiety on an undifferentiat­
ed level of structure. From such clinical experiences we can conclude that therapeutically
relevant diagnosis depends on structural organization, not on descriptive symptoms.
70 B. Killingmo Scand J Psycho! 26 (1985)

2. Psychoanalysis and psychoanalytically oriented psychotherapy

Although the debate on the widening scope of psychoanalysis (Stone, 19S4) has extended
the conception of analyzability, limits for the analyzable structure are still set rather
narrowly. In line with this there is a tendency to preserve the distinctive quality of
psychoanalysis by restricting it to interpretation. Perhaps Anna Freud is the one who most
consistently has insisted on the limited application of psychoanalysis as a treatment
procedure. She reserves it for the neurotic conflict proper, refusing to allow that it may
have a corrective effect on developmental fixations: "The pathogenic sequence of frustra­
tion, regression, internal incompatibility, anxiety, defense by repression, return of the
repressed and compromise formation-the sequence which is characteristic for the neur­
osis-is relieved by analytic work which lifts all partners in the process to the same level
of consciousness and thereby enables the patient to find different, healthier and adaptive
solutions for his conflicts. Developmental pathology, on the other hand, does not respond
to interpretation. Even if confronted with the details of their aberrant development and the
reasons for it, children or adult patients remain quite unable to alter what has happened
and what is, after all, the very basis for their personality structure" (1981, p. 118). This
means that psychoanalysis is applicable only in relation to intrapsychic conflict. To profit
from psychoanalysis, the patient must have reached a structural level where he has the
capacity for developing a neurosis. From a theoretical and logical point of view, the
argumentation of Anna Freud is quite clear. The ego can only reassess conflicting
elements which are part of the personality, that is, which are internalized. It cannot
resolve conflict where one part was exterior to the child and has remained so. In other
words, analysis is reorganization of existing structures, not building of new ones.
However, this dogmatic position of Anna Freud seems to be modified by clinical
experience. First, there is convincing clinical evidence that also less-developed structures,
even so-called borderlines, may profit from analytic technique. Gedo says: " ... certain
weighty disturbances of mental functioning have no direct connection to the intrapsychic
conflicts of the oedipal period but can nonetheless be successfully treated by the classical
psychoanalytic method" (1981, p. 86). Second, it is an open question whether the neurosis
proper really exists. The last two decades of widening scope of psychopathological
understanding makes it more reasonable to count on developmental unevenness also in the
so-called good neurosis. From an organizational point of view, we may expect to find
developmental arrest and intrapsychic conflict in all sorts of combinations. Thus in a given
pathological pattern some components may be traced back to very early defects in
structuralization, others to early external conflict or empathic failure, while others may be
the result of internalized conflict. To handle therapeutically such an organized pattern of
complex origin, it seems necessary to change technique as the different components of the
pattern come into focus. Thus, it may be appropriate to start with an analytic procedure in
relation to the pattern as a whole, then change to ego-building and self/other differentiating
measures, before the pattern as a whole is again interpreted on a conflictual level. By
analytic procedure I mean interpretation of resistance and internal conflict, whether it be
oedipal or not, and whether inside or outside the transference. The main point advanced
here is that an analytic procedure can be applied to those elements in the patient's
structure where conflict prevails, whi l e other elements have to be treated with other
measures. Thus, technique may oscillate between analytic and non-analytic measures
throughout the entire treatment process, depending on the level of structural organization
at any time. With this perspective the role of the therapist can be formulated as a mediator
of organization (Horner, 1980).
To be a good mediator, the therapist must be a keen listener. On face value the material
Scand J Psycho! 26 (1985) Psychoanalytic theory: Lines of advancement 71

brought out in the session may have a flavour of high organization. This may mislead the
therapist to intervene on a level not corresponding to the level where central emotions are
organized. Therefore the therapist has to listen carefully to subtle undercurrents in the
materia I to determine in what way and to what degree the present psychological field is
organized in terms of earlier structural deficits or derivatives of such. To sum up: The
therapist has to adapt his intervention within three contexts of organizational variation: (I)
From one patient to another. (2) In the same patient from one moment of time to another.
(3) In the same patient from one area of personality to another.
Psychoanalysis is traditionally considered the treatment of choice for the neurotic
patient, while psychoanalytically oriented psychotherapy is considered the appropriate
procedure of treatment for the preneurotic patient-where structural deficiency prevails.
However, as therapeutically relevant understanding of personality is moving away from
diagnostic entities to individual profiles of structural organization, it seems about time to
ask whether it is productive to emphasize the difference between the two therapies. To
fixate one point when it is correct to switch from psychoanalysis to psychotherapy would
be as misleading as to establish one dividing mark between a neurosis and non-neurosis. It
is not argued that the differences between the two should be declared non-existent,but that
the two be integrated within a broad psychoanalytic developmental theory. Covering the
entire spectrum of structural development, such a theory would allow for systematic
interventions according to the actual level of ego-organization. Or as Gedo puts it: ''... to
elaborate technical interventions tailored to the specific mould of mental organization
prevalent at each phase of childhood and in the adult conditions that correspond to those
phases" (1981, p. 12). In my opinion we are then performing neither psychoanalysis nor
psychoanalytically oriented psychotherapy, but simply psychoanalytic therapy.

3. The theoretical language of psychoanalysis

Perhaps future psychoanalysis-if such a separate branch as "psychoanalysis" continues
to exist-will be formulated in a radically new theoretical language. Attempts to this end
have already been made (Bowlby, 1981; Peterfreund, 1971; Schafer, 1976). Especially as
regards early personality development, psychoanalysis is in need of a new language to
replace the present adultomorphizing and pathologizing way of describing the normal child
( Peterfreund, 1978; Robbins, 1980). Another shortcoming of the language of traditional
psychoanalysis-especially that of conflict-is that it presupposes the existence of mental
representations and a certain degree of self/other differentiation. This makes it unfit for
description of early states of development where lack of differentiation prevails. One
alternative is to assume, as Melanie Klein does, that mental representations and thereby
conflict, exist right from birth. In my opinion many of the Kleinian concepts may serve as
clinical metaphors in treatment of the older child and the adult patient. However, as a
scientific valid language for describing the neonate, Kleinian conceptions cannot be
accepted. We have to conclude that traditional psychoanalysis is without a language that
can account for the transition from undifferentiated to differentiated structure in a consist­
ent manner. There is an inherent discontinuity in the description of development. It seems
necessary to start as Robbins says: " ... afresh with new terminology more appropriate to
the undifferentiated state, and an epigenetic model emphasizing gradual differentiation and
integration" (1980, p. 481).
The psychoanalytic language of cathexis implies concepts that are beyond empirical
validation. It is this kind of language that puts psychoanalysis in an iso l ated position in
relation to other psychological theories and areas of research. In their efforts to carry out a
truly psychoanalytic study of infant development, Stechler & Kaplan report: "In both
projects, however, it became evident that the metapsychological concepts subsumed
72 B. Killingmo Scand J Psychol 26 (1985)

under the rubric of the economic, structural and dynamic points of view were not
applicable to the data flowing from direct observation. Furthermore, there was no way of
bridging the gap between metapsychology and the data emerging from such fields as
neurophysiology, ethology, psychology and genetic epistemology" (1980, p. 85).
A theoretical language based on the idea of a central organizing process could possibly
be an alternative. A conceptualization of development in terms of differentiation, integra­
tion, establishing of part-structures, and the organization of these in hierarchical patterns
would not imply discontinuity. The organizing process is present at birth and will continue
irrespective of arrest or fixations; that is: Also the fixations will be organized. It is likely
that formulation of psychoanalytic observations in such a language will provide a rap­
prochement to other fields of psychological research, especially cognitive psychology. It is
not contented that the dynamic language of conflict and regression should be abandoned,
nor the language of self/object representations. They will still be useful for specific
purposes. But they will remain part-languages, subordinate to the organizational point of
view.

CONCLUSION
In two articles controversies in present-day psychoanalytic theory have been discussed.
It is maintained that incompatible views exist side by side under the heading of psychoana­
lysis, and that concepts from conflicting frames of reference are used interchangeably in
clinical practice. However, this may not be so alarming if the conflictual situation is fully
realized and not concealed either by ignorance or by constructing pseudo integrating
theories. In such an open spirit one can hope that a new inclusive psychoanalytic theory
will emerge. Perhaps we should not expect a radically new theory to come all at once. In
all probability the theory will develop slowly through a process of clearance. New
concepts will be combined with the best of the old ones. Some will be given a more central
position in the theory while others will be moved to the pheriphery. We cannot say today
what the final product will look like. However, on the basis of the above survey of
conflictual issues, some requirements for a future theory may be formulated.
The theory should: (1) be in the nature of a developmental theory; (2) cluster around the
organizing process and the establishment of hierarchical patterns of structure; (3) imply no
discontinuity between early and late stages of development; (4) include both drive gratifi­
cation and dependency as primary motivational forces; (5) include both developmental
arrest and conflict/regression as mechanisms in development of pathology; (6) include
both pre-neurotic and neurotic phenomena and allow for an individualized description of
pathology; (7) establish a basis for interpretation of symbols and projective material
including wishes and needs from different motivational sources.
In choosing the overall language for this theory, one should decide in favour of concepts
providing the best rapprochement to other diciplines of psychology. Eventually this may
lead to the extinction of psychoanalysis as a separately organized body of knowledge.
However, the importance of the psychological insights obtained by practising the psy­
choanalytic method will not be diminished even if they appear in a new scientific language.

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