In his first chapter Michael Balint reviews changes made by Freud in his formulation of therapeutic techniques and aims in psychoanalysis. In an initial period Freud strove to make the 'unconsciousconscious', to overcome the patient's 'resistance' mainly by persuasion, and to remove his 'infantile amnesia' leading to the uncovering of the Oedipus complex. This period the author calls that dominated by a dynamic orientation. Its emphasis was on the id, and content analysis was in the foreground. The next approach was the topical one. The neuroticsymptom was seen as a compromise between the id, ego, and superego. Freud formulated 'where id was ego shall be'. The emphasis lay on helping the patient to give up costly defense mechanisms and adopt new ones of greater economic value.
Balint holds both formulations limited inasmuch as they take only the individual into consideration. He calls this limitation the 'physiological or biological bias'.
The second chapter holds that a new orientation took place with the observation of 'formal elements'—the observation of the patient's behavior in the analytic situation. This is intimately linked to the patient's character and these formal elements are part and parcel of the 'transference', i.e., an object relationship. The author maintains our technique is now ahead of our theory: we know fairly well how to deal with complicated problems of object-related attitudes or emotions, but are unable to describe them adequately or label them in our diagnostic statements.
The third chapter tries to explain the historical reasons for this difficulty. Freud based his psychological theories on his clinical experiences with obsessional neurotics and his studies on melancholia. Mrs. Klein followed him in the latter. The common quality of these pathological forms is their 'withdrawal from objects'. Hence the lack of a consideration of object relationships in the theory. The 'physiological or biological bias' should be supplemented with an 'object relation bias'.
In his fourth chapter Balint states: 'My contention is, that if we describe the events only from the point of view of the individual, using our well-developed technical terms and concepts such as repression, regression, split, establishment of a severe superego, introjection and projection, displacement, fusion or defusion, ambivalence, etc.—our description, though correct, will be incomplete, for every neuroticsymptom means also a distorted object relation, and the change in the individual is only one aspect of the whole process'. Mrs. Klein's theories go a long way toward meeting the author's demands. The most important field for investigation of his point would be the analytic situation
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including the analyst's libidinous relation in it. A second source would come from direct observation of children. A third field is being opened by group therapy, or observation of natural groups.
In lieu of summing up, Balint illustrates the difference in therapeutic approach by the example of the treatment of the silent patient. The object relationship approach would be expressed by 'creating the proper atmosphere' to enable the patient to open up, or 'avoiding' an atmosphere which shuts the patient up.
In the end the author subscribes to John Rickman's ideas according to which we may speak of a 'One-Body, Two-Body … and Multi-Body psychology'. Up to now psychoanalytic theory has in the main been a 'One-Body psychology'.
This paper is an important one. It should be read, discussed and thought about.
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Wangh, M. (1952). International Journal of Psychoanalysis. XXXI, 1950. Psychoanal. Q., 21:140-141