Listening Perspectives in Psychotherapy, 20th Anniversary ed.

Having read this book as a resident not long after its original publication, I was curious about the 20th anniversary edition. How might Hedges’ text, which I recall as richly informative, speak to clinical practice these many years later?

Psychotherapy and psychoanalysis have had multiple crises over the past two decades, both in their paradigms and in their institutions, but psychoanalytic theory—which Hedges makes clear is psychotherapy’s vital parent—is remarkably robust. Psychoanalytically oriented psychotherapy is clinically vibrant because of the multiplicity of theories that have evolved in the past 50 years, and Hedges seeks to capture these theories. In the introduction to the current edition (which is much unchanged from the original), he is pleased that “the Relational movement…spawned by Greenberg and Mitchell’s 1983 Object Relations in Psychoanalytic Theory [1]” has flourished, established lines to its progenitors, and taken an interest in Listening Perspectives (pp. xxi–xxii). He recognizes as kindred, among many others, Sandler, Stolorow, Atwood, Oremland, and Ogden.

Our theories, Hedges understands, determine what we listen to and what we hear in our patients. A postmodern, relativistic, and, I would add, antiauthoritarian stance fueled this understanding to advance the relational movement as interpretive, intersubjective, and experiential as opposed to the positivist, intrapsychic, and dogmatic posture of ego psychology of the 1950s.

Basically, Hedges seeks to hear clinical material within a developmental frame, which he parses into four listening perspectives and related diagnoses: 1) neurotic level issues associated with oedipal themes and object constancy, 2) narcissistic presentations associated with issues of self-integrity and esteem, 3) borderline pathology associated with issues of merger and separation, and 4) schizoid or psychotic organization associated with part-objects and inchoate sensory experience. In the examination of each of these, the territory becomes familiar. Neurosis is best served by Freudian theory, of which Hedges offers a perfunctory review. The chapters on narcissism—approximately 50 pages—are devoted to a good and concise review of Kohut’s work and examples of the clinical practice of self psychology. Those on borderline pathology—approximately 120 pages—draw on the work of a number of seminal authors—Jacobson, Mahler, Kernberg, Masterson, Bollas, Hartocollis, and Giovacchini, among others, with earlier reference to Klein and Winnicott. There is rich clinical material that is well integrated with the theoretical discussion. Hedges appears to use the term “scenario” to mean something enough akin to transference or transference enactment that I am not convinced there is utility in offering a different word. The final and developmentally most primitive listening perspective, related to schizoid and psychotic functioning, incorporates the work of Klein, Fairbairn, and Guntrip, then Searles, Bion, Little, Grotstein, and, again, Giovacchini and Bollas. Again, there is abundant clinical material. The penultimate chapter discusses controversies between Kohut and Kernberg as well as such diverse contributions as those of Langs, Schafer, Lacan, and Sartre.

Listening Perspectives is an ambitious and multifaceted work, particularly suited to use as teaching material for the serious student. It performs an important service of reviewing, organizing, and contextualizing contemporary psychoanalytic thought, and it did so before relational concepts were as comfortably integral as they are today. In this respect, there is less need for a covert agenda of theoretical revolution. One is cautioned that reification of any construct may become dogma. As Freud wrote, “In psychology we can only describe things with the help of analogies. There is nothing peculiar in this; it is the case elsewhere as well. But we have constantly to keep changing these analogies, for none of them lasts us long enough” (2).