May 1996, Vol. 2, No. 3

A Relational Model of Psychopathology and Therapeutic Change
By Denis Cronin, second-year clinical student.

In Relational Concepts in Psychoanalysis: an Integration (Harvard University Press, 1988), psychoanalyst Stephen Mitchell has developed a model of psychopathology and therapeutic change that, unlike more traditional psychoanalytic models, locates the origin of most forms of psychopathology in the individual's investment in maintaining a narrow matrix of self-defeating social and interpersonal relational patterns. As a model of psychopathology and change, Mitchell's model in Relational Concepts, is fast assuming the status of "Chinese boxes" in both its inexhaustible conceptual richness and in its range of clinical applicability.

To Mitchell, all psychodynamic phenomena are viewed as embedded within a multifaceted relational matrix that takes into account self-organization, attachments to others, interpersonal transactions, and the client's continual recreation of his subjective world. The most useful way in which to view psychological reality for Mitchell is as operating within a relational matrix that encompasses both intrapsychic and interpersonal realms. These realms are seen as "creating, interpenetrating, and transforming" each other in a myriad of subtle and complex ways. Like the more Freudian drive model of psychoanalysis, Mitchell's relational model places a great deal of emphasis on conflict as the central psychodynamic struggle in human experience. Yet, rather than localizing conflict in the interplay among the psychic agencies of id, ego, and superego, Mitchell's more relational model of conflict replaces the central antagonists with "relational configurations; the conflictual passions within any single relationship; and the competing claims among different significant relationships."

One of the most clinically useful features of his model lies in its assertion of the critical role played by personal agency and accountability in the psychologically ill person's present functioning. However damaging their past experiences and however strong the influence these exert on their present functioning, to Mitchell the influence of the will always looms foremost. Mitchell's stress on the pervasiveness of agency and personal accountability in accounting for one's functioning is liberating because it suggests that psychopathology always involves the client's active and willful dedication to a relational matrix that weaves together past, present and future in a familiar way.

The "metaphor of the self as damaged," inherent to most psychoanalytic models of psychopathology, does convey a powerful experiential truth. However, Mitchell admonishes that the predilection to experience oneself as damaged serves to sustain the rigid self-organization, adhesive ties to others, and security-maintaining transactional patterns that play a central role in mediating our connections to others. The connections that are mediated through the metaphor of damage in Mitchell's model may be real or imagined. Yet, the sense of damage functions as the veritable centerpiece of the client's relational matrix, protected because of the role it plays in holding together a sense of connectedness to others. Eventually the analysis needs to inquire into the dynamics associated with the client's commitment to the experience of himself as damaged and of the importance of that experience in maintaining the client's relational matrix.

To Mitchell, reification of the metaphor of damage as is done in more traditional forms of psychoanalysis is misleading and overlooks the power of the metaphor in organizing the interactional field. In Mitchell's model of psychoanalysis, transference involves the client structuring the analytic situation in an effort to reach and engage the analyst with all his idiosyncrasies in the only way the client knows. For Mitchell, the client interactively encounters the analyst in all his individualized presence, rather than merely transposing onto the analyst something foreign.

The result of this more fluid notion of transference is that the analyst is constantly in the midst of the transference-countertransference integrations of the client, shaped by the client's struggling to understand and reshape them from within. Mitchell envisions the therapeutic relationship as one comprised of continual oscillation between old and new relational configurations, between the articulation of the passions and organizational structures of the client's phenomenology, and the introduction of the analyst's perspective.

Denis Cronin is a second-year clinical student.
His field placement is at University of Chicago Hospitals, Child Psychiatry.

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