Preface – Heinz Kohut and the Theory and Practice of Psychotherapy
Heinz Kohut and the Theory and Practice of Psychotherapy
It is clear that to understand Heinz Kohut he needs to be relieved of his language. And yet despite his abstractions and even contradictions, Kohut was the transformative thinker whose work represented a paradigm shift from the classical tripartite model of id/ego/superego, based on an elaborate theory of instincts and drives, to one of the self as a holistic construct. Kohut was not alone in challenging the drive theory of Freud and ego psychology that reigned supreme in the middle of the 20th century. Psychological thinkers as early as Carl Jung questioned Freud, and his challenge was later picked by Erik Erikson, British psychoanalysts like Donald Winnicott and Melanie Klein, and a host of quieter voices like Ronald Fairbairn. Some have even suggested Kohut is not on a par with these figures. At the very least one can say many serious and smart thinkers in mid-century strenuously objected to the dogmatic and hegemonic rule of drive theory in clinical psychoanalysis. They yearned in various ways to treat immediate experience and to respond in more empathic ways to the needs of patients than the theory allowed. But their challenges were piecemeal, disconnected, and sometimes conceptually confusing. Some wrote movingly and empathically about clinical issues but fell back on drive theory to explain their clinical experiences. Others branched out in new ways conceptually but failed to develop a consistent general theory. There was, in other words, no coherent alternative perspective to drive theory within the psychological and psychoanalytic worlds. And yet things were changing. The idea of self was in the air, as was a yearning for empathy and mutuality.
We argue in this book that there are two foundational thinkers in the history of psychoanalysis: Sigmund Freud and Heinz Kohut. Freud has had his due and been adequately appreciated for his ideas, even if few engage any longer in his mode of treatment. Kohut is much less well known. He wrote in dense language and even his best ideas got buried in pedantry. But Kohut revolutionized psychoanalytic thought and the practice of psychotherapy, bringing empathy into the heart of the project. He reimagined psychotherapy in a way that made it inclusive in an age of diversity and social change. There are many forms of contemporary psychoanalytic and psychotherapeutic practice, but the most interesting and important derive from the paradigm Kohut introduced. This book takes on the challenge of revisiting Kohut. It is worth knowing where we come from in the world of psychotherapy. It is fair to say that Kohut did for the self what Freud had done for the unconscious: pull together loose strands of ideas in the clinical and intellectual world and weave a new theory that was consistent and appropriate for the historical moment.
All kinds of important ideas flow from the new way of looking at things psychologically that Kohut introduced. Empathy is the air we breathe psychologically. The self functions as a system in its world of others. We are only whole in the context of another, truly an I-thou system. Development occurs in that context. Clinical practice, which was evolving in any event from the strict rules Freud laid down, now gained a theory to explain why the best modes of treatment are mutual, open, fluid, flexible, and, of course, most of all based in the deep empathic immersion of the therapist into the feelings, affect, and experience of the patient. Time had eroded much of the humanism in the Freudian legacy. Psychoanalytic theory and practice, for various historical reasons, had become anachronistic, committed to values of autonomy despite a yearning for connection; focused on grim ideas about insight despite a pervasive interest in empathy after war and holocaust; and obsessed with the intricate workings of guilt despite the culture’s embrace of the tragic. Psychoanalysis and the clinical world was fragmented and in disarray. Kohut said he often felt pitch-forked from one conceptual level to another in reading thinkers in the field. He felt the need to start from scratch to imagine the self in new ways and soon defined clinical psychoanalysis and psychotherapy in general as a form of treatment appropriate for troubled souls desperate for empathy, mutuality, and connection.
Born in Vienna in 1913, Kohut was raised in an assimilated Jewish family, imbued with European high culture. His father, Felix, was on track to be a concert pianist before World War I, and his mother, Else, was a good singer who accompanied her husband sometimes in soirees on the Viennese Ring. The protean young man Heinz was deeply informed about music and opera, classic and contemporary art, the great literature of Greece and Rome, as well as contemporary Germany, and much else. As a university medical student between 1932 and 1938 (not specializing in psychiatry), Kohut was mostly interested in writers like Thomas Mann, painters like Egon Schiele, and of course, given his knowledge of music, all the great musicians of Vienna from Beethoven to Arnold Schoenberg and American Jazz. He first began seriously to think about psychoanalysis as a byproduct of his successful therapy in the late 1930s with August Eichhorn, though war and emigration delayed systematic immersion in Freud until the mid-1940s and in Chicago. He then, however, read the master with all the enthusiasm of a convert and came to present himself as more Freudian than Freud, “Mr. Psychoanalysis” as he later joked.
Kohut’s own sexual and identity confusions nevertheless fitted him uneasily into the world of psychoanalysis as Freud constructed it. Kohut’s project became that of changing the theory to finding a place for himself in it. Kohut’s initial forays into new conceptual terrain from 1966 through his first book, The Analysis of the Self, in 1971, were written and undoubtedly experienced by him, at least in part, as merely rounding out the oeuvre of Freud. The transformations of narcissism that he described in 1966, for example, were conceptualized implicitly as nothing more than a useful extension to what Freud first formulated in 1914; the first sentence of his paper quotes Heinz Hartmann’s definition of narcissism as the “libidinal investment of the self,” and the very idea of transforming narcissism is presented simply as a modest extension of Freud’s ideas. It is not surprising that Anna Freud initially embraced Kohut’s work with enthusiasm and for the moment they became fast friends. He undoubtedly gave away too much. Even his book five years later reads on the surface as merely deepening existing understanding of those patients previously felt to be unavailable for psychoanalytic treatment. In fact, however, Kohut was treading in new waters that even he failed to understand fully. One can reasonably say that it took most of the next decade for Kohut to work out the implications and meanings of The Analysis of the Self. It took him a decade to understand himself. Such is the mystery of discovery.
That theory of what he came to call “self psychology” helps make sense of the history of psychoanalysis up to that point. Kohut’s ideas about self allows us now to appreciate earlier thinking that was marginalized in the hegemonic years of ego psychology. After Kohut the past makes much more sense, showing, as is so often the case in intellectual history, that knowledge seldom moves in a linear fashion. It is only because of Kohut, for example, that we can fully appreciate some of Ferenczi’s later work, or the thinking of Otto Rank, and most of all the very important shards of insight in Carl Jung when he was not lost in mystical and cultural rumination. There is no question that Freud reigns supreme as the founder of psychotherapy and for his ideas on the unconscious, but the shift in perspective brought by Kohut makes us now aware in new ways of a very relevant tradition that begins with William James, runs through Pierre Janet, and re-surfaces with thinkers like Donald Winnicott. For many years such thinking that is so relevant for understanding trauma and other issues ran like a submerged underground stream beneath the huge dyke of ego psychology. Kohut released the waters.
Even more importantly, Kohut’s work defined the contours of theory making and a new openness to practice that has shaped contemporary psychoanalysis and psychotherapy. In the course of the 1970s until his death in 1981, Kohut developed a theory that freed psychoanalytic thinking from the drive model but retained its multifaceted perspectives and located practice firmly in an empathic context. Contemporary models and orientations have all sought in legitimate ways to extend aspects of Kohut’s work in their own terms. Our argument, however, is that most contemporary thinkers in psychoanalysis fail to recognize, or are reluctant to acknowledge, that they are all children of Kohut.
William James had it right. The classic steps in the life of a theory are, first, it is attacked as utterly absurd. Then it gets accepted as obvious and insignificant. Finally, it is understood as so important that its opponents claim that they had said it all before.
A Man of Contradictions
He could be difficult, this Heinz Kohut. He was often impossibly self-centered, at times almost with a certain innocence, and grandiose to a fault. One had to sacrifice a measure of self-esteem to be close to him and get the gift of what he had to offer. Kohut, for example, could be scornful when he detected the thin cultural knowledge of many Americans (“You don’t know Alban Berg’s violin concerto of 1937?” he might ask with a raised eyebrow in genuine astonishment). He deeply offended old friends with his self-absorption, especially during his last decade and a half of intense creative work on the self. He knew he was venturing into theoretical terra incognito that left the old guard dismayed and increasingly annoyed. Partly in response but also to shape a self-psychology movement, he surrounded himself with the young Turks of the Chicago Institute for Psychoanalysis—“The Group”—leaving the Freudians to fume on the sidelines. The critics were relentless. At conferences and meetings there were those who literally shunned him by turning their backs to him when he entered a room. Yet Kohut could not be ignored. He was the new voice of psychoanalysis. He imposed himself on any gathering of three or 900. He was brilliant, outgoing, and compelling. For the most part, you felt better after a conversation with him, or listening to him lecture, or hearing him speak extemporaneously, and you certainly learned something.
There is a parable here in the play and later the movie, Amadeus. This classic story depicts a fictionalized version of the rivalry between Antonio Salieri and the young Wolfgang Amadeus Mozart in the Viennese court of Emperor Joseph II in the latter part of the 18th Century. Salieri, the court composer, is competent, productive, and the author of numerous operas much beloved by the Emperor and his entourage. Salieri knows all the proper etiquette of survival in the court. He dresses well and knows how to be obsequious and meekly deferential. Salieri’s work, however, which is diligent and eminently respectful, lacks creativity. He is the safest of composers, but he cannot bring life and vitality to the lines of his music. Suddenly, the young Mozart appears at court. He is brash, obnoxious, a womanizer, too often drunk, and whines loudly when things don’t go his way. But when he sits down at the piano God speaks through his fingers.
Origin of Book
In 2014 a small group of therapists in New York—David Strug, Konstantine Pinteris, and Kathleen Kelley–asked Charles Strozier to lead a supervision group based on the ideas of Kohut and self psychology. Over the years the group evolved with the addition of Deborah Mart and, sadly, the death of Strug in 2020 from Covid 19. The project as it was originally conceived also evolved from a supervision to a writing group, as we realized we had much to say that was original in our close read of the writings of Kohut. We wrote a series of articles in scientific journals on the self, rage, termination, dreams, and sexualization before coming to the conclusion that we really should expand our work into a book. We were pleased that Oxford University Press took on our project in 2019.
We have intentionally aimed the book at a wide audience of clinicians, including, of course, psychoanalysts but also social workers who often long for a deeper understanding of the ideas behind psychotherapy; psychiatrists who incline toward treatment that is not solely based in drugs; and indeed all those who continue to believe that talk therapy will always have a place in treating the troubled. Kohut is too important a thinker to be relegated to a niche in the history of psychological thought.
In this book we blur the line between psychoanalysis and psychotherapy. We do not privilege analysts as cornering the therapeutic market. That is the point. Except when quoting Kohut in what are his references to “analysts,” we always mean psychotherapists in general, in other words, all those clinicians who practice talk therapy. Freud invented psychotherapy as the first disciplined approach to the “talking cure,” as Anna O. called it in treatment with her remarkable listener, Joseph Breuer (whom Kohut once called the first psychoanalyst). Freud called his version of psychotherapy “psychoanalysis” and laid down specific rules for its conduct. For most of the first half of the 20th century, psychoanalysis as Freud defined it reigned supreme in the clinical world. Lying on the couch for four to five times a week, examining dreams as the royal road to the unconscious, and privileging interpretations that an all-knowing (and usually male) therapist provided was regarded as the pure gold of healing for most forms of psychiatric and psychotherapeutic disturbance. Psychotherapy, which was more loosely defined and eschewed use of the couch, was seen as not quite the real thing, as merely a base alloy. For all kinds of historical and social reasons the belief in Freud’s approach to treatment lost much of its value by the 1970s. Somewhat ironically, Kohut, who began as an ardent disciple of Freud’s thought and approach to therapy, defined an altogether new set of ideas for psychoanalysis in the course of his burst of creativity between the mid-1960s and his death in 1981. Many others paved the way to his work. His contribution was to integrate those disparate strands of thought and reimagine the theory in ways that made practice relevant for a new world. Kohut invented the pure gold of psychotherapy.
Our book, in other words, is ambitious. We want to remind the wide and diverse range of clinical psychotherapists, students, and scholars from psychology to the humanities of the significance of a major thinker who far too often is relegated to the margins. Our goal is to make Kohut’s ideas clear and accessible. In the process, we hope to restore him to his proper place in the recent history of psychological thought.
 “Kohut is not as strikingly original as were Lacan, Klein, Winnicott, and Bion.”
Christopher Bollas, “Who Does Self Psychology Cure? Psychoanalytic Inquiry 1986 (6):429-435.
 William James, Lecture VI of Pragmatism’s Conception of Truth (1907), The Works of William James, ed. Frederick H. Burkhardt, Fredson Bowers, and Ignas K. Skupskelis, 16 vols. (Cambridge, MA: Harvard University Press, 1975), 2:95.
 David Terman first brought this parallel to the attention of Charles Strozier in 1985.
 Strozier, Heinz Kohut, 271-72.
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