Freedom to Choose: A Book Review

Rita Teusch, PhD, Faculty Member of BPSI. Her remarks below originally appeared in the Winter 2018 issue of the Hann Sachs Library Newsletter, which can be read here.

This immensely readable book details John and Kerry Kelly Novick’s clinical psychoanalytic work over the past 50 years. Trained at the Anna Freud Center in London in the 1960’s, the Novicks’ clinical work and research has focused on various degrees of destructive and self-destructive sadomasochistic behavior in children and adults. Their Two-Systems Model of Self-regulation was first introduced in 1972 and has been elaborated ever since. Even now the authors still see their model as a “work-in-progress” and invite readers to send them feedback about its clinical usefulness.

The book is organized in two parts: the first part delineates developmental challenges from infancy through old age and outlines resolutions resulting in open versus closed system functioning. The second part illuminates how the two-systems model can inform and enhance clinical technique throughout the various phases of an analysis. The authors provide useful clinical recommendations with regard to conducting evaluations, building a therapeutic alliance and “emotional muscle” to support open-system functioning, or termination, always with an eye as to which system of functioning is prevalent in a patient.

The two-track model of these authors came into being when they realized they needed a new conceptual framework to better explain the clinical phenomena of persistent sadomasochism and omnipotent destructive beliefs that often remain stable in certain individuals throughout their lives. The Novicks’ thesis is: a closed-system of self-regulation develops as a result of cumulative environmental trauma. It is characterized by repetitive patterns of omnipotent, sadomasochistic beliefs and fantasies, i.e. defenses of magical power and control that initially provide the individual with a sense of mastery and safe self-regulation. It is not a deficit model, but the defenses, developed throughout various phases of development, constitute the person’s best efforts to meet legitimate basic needs and resolve conflicts. An open system of self-regulation, on the other hand, allows the individual to be attuned to his/her inner and outer reality and is characterized by joy, competence and creativity. During a psychoanalytic treatment, both these systems of self-regulation are present at various times and need to be recognized and analyzed. The clinical challenge is to help patients gain awareness and self-reflection so that they can begin to have a choice as to which system of self-regulation they employ.

The Novicks’ model of two systems of self-regulation integrates ego psychology and relational psychoanalysis by not prioritizing the intra-psychic or the environment, but by highlighting how early adverse environmental interactions become internalized and part of intra-psychic conflict. They submit that a more classical psychoanalytic approach of transference and resistance analysis is often needed to put the patient in the active center of his psychopathology, whereas transference and resistance interpretations may undermine competency in open-system functioning, pathologizing the patient’s strengths. Successful analytic interventions in open- system functioning include mirroring, empathy, reconstruction, validation, support, and developmental education.

I highly recommend this interesting book to any student of psychoanalysis, but also to experienced clinicians. It contains the authors’ sophisticated analytic understanding and conceptualizations resulting from decades of intensive psychoanalytic work and research, especially the treatment of persistent sadism and masochism, whether in reality or the patient’s fantasies. While many of us may be familiar with the work of the Novicks, I found it a pleasure to encounter their lives’ work distilled in a highly readable book, which even includes an annotated biography of the authors’ published papers throughout the last five decades. With Alan Sugarman, I feel that this book will move us beyond today’s pluralism toward a model that utilizes all that our disparate schools are teaching us about mental functioning, pathogenesis, and therapeutic action.

About the Author

Rita Teusch, PhD, is a Training and Supervising Analyst and faculty member of the Boston Psychoanalytic Society and Institute. She is a part-time Lecturer in Psychiatry (Psychology) at Harvard Medical School, Cambridge Health Alliance, and provides supervision to psychology interns and postdoctoral fellows at Cambridge Hospital. Dr. Teusch has a private practice in Harvard Square, Cambridge, MA

Rita Teusch can be contacted by email here.

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