What's a Good Object to Do? - PsyBC

34 Jay Frankel
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analysts also appreciate that patients’ behavior and attitudes can reflect
familial roles, cultural values, and adaptations to their therapists and
to the meaning that therapy has for the patients, as well as reflecting
personal psychopathology operating independent of the situation.
Alongside a theoretical appreciation of contextual influences on
personality functioning, diagnosis also carries the danger of reifying
as known what is in reality always partly unknown about another
person, with the consequence of limiting clinical possibilities. In
practice, relational analysts tend to avoid thinking in diagnostic terms.
But even giving contextual influences their due, and acknowledging
that it is impossible to know someone else totally objectively and in
all aspects, all but the most radical postmodernist would accept that
people do have certain personality characteristics, including personal
limitations, that are distinctive and that endure over time. Indeed, if
people’s personality problems were not so predictable, tenacious, and
resistant to new influences, the idea of analytic treatment would make
no sense. Diagnosis is an idea that, it seems to me, cannot be given up
so easily.
Yet there is also almost always some degree of fluidity in people’s
functioning. At times a diagnosis can appear to change quickly. The
familiar concept here is regression. All of us have the capacity to regress
or shift to more primitive levels of functioning, within a range that
varies from one person to another and in ways that are responsive and
more or less predictable according to the situation (see Epstein, 1979).
Some people are more resilient in the face of potential disruptions to
functioning while others are more vulnerable (Garmezy and Rutter,
1983). Acknowledgment of the potential for changeability within each
of us, combined with the recognition that at any given moment each
of us is functioning at a certain point on our own regressive continuum,
leads to the concept of “diagnosis-of-the-moment” (Frankel, 2005).
Killingmo (1989) has written about everyone’s personality
containing aspects of both conflict pathology and deficit pathology,
which interact in complex ways. In the analytic setting, these can
result in what he calls conflict- and deficit-transferences, each with
typical characteristics. Which of these is ascendant “is variable . . .
within one and the same patient from one point of time to another or
from one area of personality to another” (p. 66). An analyst must
therefore be prepared to respond differently from moment to moment.
Killingmo proposes that, when deficit transference is operating,
affirming responses from the analyst are called for; whereas, when