APPENDIX ONE
THE DISTINCTION BETWEEN ANALYTIC AND INTERPERSONAL
OR‘OBJECT RELATIONS’ THERAPY

Psychodynamic psychotherapists who err towards the analytic pole, follow closely in the tradition of Freud. For Freud and the early analysts (e.g. Ernest Jones and Georg Groddeck, Karl Abraham, etc.) the patient’s problems were‘intra-psychic’—that is, the tensions emerging from the opposing demands of ego and instinct cause neurosis. The analyst’s job was to reduce these tensions through bringing to awareness the unconscious conflict. This theoretical emphasis on the intra-psychic origins of discontent entailed the clinical stance that was mainly analytical—that is, the therapist investigated objectively and disinterestedly the patient’s intra-psychic life and offered interpretations that were thought to heal by bringing insight. The relationship between certain internal dynamics within the patient was therefore more significant than the relationship between the therapist and patient.

In distinction to the analytical therapists the interpersonal or‘object relations’ therapists stressed the primacy of the inter-personal rather than intra-psychic relationship. As Fairbairn says, this relational stance‘may be formulated in the general principle that the libido is not primarily pleasure seeking [as the analytical psychotherapists urge], but object seeking’ (Fairbairn 1952: l37). That is to say, the libido finds its primary goal though forging healthy relationships with others, not in seeking the pleasure through gratifying tensions. The primary drive at the outset of lifethus becomes the establishing and maintaining of good object relations, not of satisfying instinctual needs. This shift in emphasis also has its resultant clinical stance: therapists in large part heal the patient through relationship—that is, they‘re-parent’ the patient, providing that which was lacking in the child’s early years. Thus for the interpersonal therapists, exploring the relationship between therapist and patient with all its reparative possibilities is the crux of analysis. In sum, analysts heal largely through analysing and interpreting patient material, while interpersonalists heal through providing a reparative relationship.

It must be emphasised that the new‘interpersonal’ or‘object relations’ approach does not subvert the analytic stance but rather builds upon it. For example, it still takes basic classical psychoanalytic theory and technique as axiomatic: the structure of the psyche and the characteristics of the unconscious, childhood sexuality and development, as well as psychic mechanisms such as defence and displacement, symbolisation, symptom formation, repetition, resistance, transference neurosis and working-through (King and Steiner, 1990). All these are expanded upon and developed, but never dismissed. This means that despite there having been considerable changes in psychodynamic therapy since the time of Freud, a general psychodynamic orientation has nevertheless remained constant throughout its history. It is this constancy that has enabled the UKCP to classify all these therapies under the rubric of the‘psychodynamic’, and the BPC under the‘psychoanalytic’.