Book Review by Kreg Zimmerman, MFCC
This text represents at least 10 years of the author’s development as an analyst and therapist. Using classical psychoanalytic theory, ego psychology and object relations theory he develops four Listening Perspectives to treat early developmental and personality derailments that are common in the patients and couples we treat today.
“Listening” is meant “to include all forms of information received by the analyst and any responses by the analyst that indicate his or her receipt of the information.” Listening involves our ability to subjectively grasp the patient’s inner experience. Hedges, using various psychodynamic approaches teases out each theory’s differential effectiveness in understanding our clients, realizing we are limited to only grasp and respond to that which we are prepared to hear.
The four listening perspectives are analogous to four broad classifications along a dimension of self and other differentiation and integration, to include: neurotic, narcissistic, borderline and psychotic. This self-object focus includes: (1) our early sense and experience of the “other”, (2) internal structure and personality, (3) early patterning reflected in life-long choices and (4) a person’s present personal experience. This dynamic approach has “far reaching implications for issues of child rearing, marriage and family life and most other forms of significant human interactions.”
Four Listening Perspectives
- Constant Self and Constant Object
- Merger Object
- Part Self and Part Object
This represents oedipal/post-oedipal neurotic conflicts as conceptualized by Freud. It details conflicts between our inner world and the outer world of day-to-day living and relationships.
Relying on Kohut and Hartmann, Hedges describes this earlier preoedipal period as dealing with issues of cohesion and fragmentation of the self leading to the development of object constancy. These patients are generally considered narcissistic.
The borderline personality has not reached or has only – partially reached a cohesive organized sense of self and constant other. Drawing heavily upon Mahler, Kernberg, Masterson and others, Hedges gives us a comprehensive understanding of the symbiotic and postsymbiotic emotional merger experience.
This experience of the “organizing personality” is one of inconstancy, possibly involving breaks in reality and affect regulation reflecting psychic life at it’s earliest. Using Klein and the British School of psychoanalysts Hedges deals with the experiences of schizophrenia and the affective mood disorders.
Of particular use to the reader are Hedges clinical examples drawn from his own practice and those of other clinicians. The book has detailed theoretical discussions, to include far reaching metapsychological considerations. (I found these difficult and more than I wanted to know but the clinician who pushes through them should find themselves much better grounded than the average clinician). He includes a pleasurable overview of Freudian theory (Listening Perspective One), an analysis of Kohut’s contributions (Listening Perspective Two), Kemberg’s theory (Listening Perspective Three), and a discussion of Klein’s usefulness (Listening Perspective Four).
The final chapter includes an analysis of the new wave of psychoanalysis, elucidating Stolorow, Lachman, Langs, Schafer, Lacan and Satre, as well as an interesting critique of Kohut as seen from Kemberg’s perspective. While this chapter is 10 years old it provides an interesting understanding of still occurring trends within the field.
The reader will find Mahler’s theory a significant contributor to this volume. Her ideas are used as a hinge by Hedges to understanding issues of self-other development and differentiation. Since the material was originally developed for advanced students and practicing clinicians, beginning readers may find the material difficult and would do well to familiarize themselves first with Mahler and basic object relations theory.
The book proves to be a difficult read at times, yet Hedges synthesizes the material well and most valuably provides a framework in which to hang different theories into a consistent usable whole.
In using Hedges’ developmental listening perspectives different psychotherapeutic approaches may be used to listen and respond to a client experiencing the world preoedipally. To not do so for the preoedipal patient would be
“a grave error of empathy. To understand the world of the infant or toddler in adult terms is simply to misunderstand. This differential response afforded by complementary Listening Perspectives holds forth a possibility for establishing and maintaining optimal empathic contact with persons presenting or expressing very different developmental phases of patterning of self and other experience.”
To not do so, per Hedges, indicates faulty listening, accounting for many premature endings of therapy, creating a severe breach of trust and empathy for the client.
The value of this book is that it gives us a framework by which to gauge our interventions. Many MFC’s are weak in having a comprehensively understood and held personality theory. Any complete personality theory will include an understanding of human development, pathology and treatment. Whether one is structural, behavioral-cognitive or communications oriented a complete understanding of human development can direct our interventions and help us gauge their success. Hedge’s book fills a gap often overlooked in our development as MFC’s, a gap that is rapidly closing if one notes Hedges book and the recent writings of Marion Solomon, Joan Lachkar, the Schafers and others in addressing marital and family therapy from a psychodynamically oriented perspective.