An Interview with Robert Emde
Part 2

Robert M. Galatzer-Levy
Science Editor

Robert M. Galatzer-Levy, M.S, M.D., is University of Chicago clinical professor of psychiatry and behavioral neurosciences and Chicago Institute for Psychoanalysis faculty member. galatzerlevy@rgalatzerlevy.com

Robert M. Galatzer-Levy

My conversation with Bob Emde moved from the forward edge of today’s psychoanalytic research to his own early research career [See “Part 1,” TAP 51/4, page 5]. He emphasized how his early career not only involved his own creative work, but centrally involved connections with colleagues. “That’s a strong point about research. It is very much a cooperative venture, sharing and working with others… For people outside of science, it’s hard to realize how much of a cooperative enterprise it is.”

Emde’s early work on affect as a mediator was partly stimulated by his earlier supervision with René Spitz, for whom affect was central. Emde began his research at a time when the Darwinian approach to affect was receiving increased recognition. He was struck that clinical psychoanalytic work was not paying attention to affect as an organizer. Instead it viewed affect as an intermittent disruptive force or even as an element in a stimulus response paradigm. Emde realized, that contrary to the psychoanalytic view of the 1960s and ‘70s, “affect was fundamental to our lives … we thought of it more as active, ongoing and adaptive instead of reactive, intermittent and disruptive.” As a clinician, Emde saw “we needed to use our emotions more and more, particularly when we were seeing suffering and pain in children, which no one wanted to see. It’s hard for us to see, particularly in babies.” This early work was done when child abuse was finally being recognized, and clinicians were “coming to grips with the painfully obvious.” The ability to recognize painful states in children and infants and not to ignore them is an example of the psychodynamic translation approach in which psychoanalytic research has had a profound effect on community practice.

Another early theme in Emde’s work began in college. He majored in sociology and cultural anthropology in addition to his premedical studies. He became fascinated with the social self. Psychoanalysis is moving in this direction. “We now realize psychoanalysis as a two-person psychology, one dependent on relationships … but the core theme is that all of our therapeutic work involves the effect of relationships on other relationships.” Emde explained, at the same time we work on the transference-countertransference relationship within the consulting room, we are also working with influencing our patients’ relationships with spouses, other intimate relationships and relationships with children. These are topics that are being increasingly explored in psychoanalytic follow-up research. We need to understand how people get better, sometimes with treatment, sometimes without it, and sometimes despite it. There needs to be more research into how relationships, certainly not just psychoanalytic therapeutic ones, help people. Analysts can explore more how we can enhance things like the doctor-patient or psychologist-patient relationship, and how these can be integrated into practice.

The conversation moved to the integration of research into psychoanalytic practice. Bob Emde reminded me of the International Psychoanalytical Association’s webpage, the “Open Door Review,” (https://www.ipa.world/ipa/IPA_Docs/Open%20Door%20Review%20III.pdf), “a wonderful resource for clinicians and researchers summarizing decades of systematic psychotherapy research.”

He went on to talk about the widening scope of psychoanalytic thinking about the unconscious. Looking back, while Freud was criticized in his day for his emphasis on unconscious mental function, “as it turns out he under-emphasized it, not just in the dynamic sense that is our everyday work. But, also in the sense of procedural, skill-based knowledge and implicit knowledge.”

Important research is now emerging on how the work within the analytic situation on the countertransference-transference relationship moves outside the analysis—to spousal and work relationships. Emde recalls when he was in training, candidates’ marriages often broke up, but this received little attention. It was assumed that was how life was. But it is really an important question why so many of the marriages of trainees ended. Emde wonders whether, during the termination phase of typical analytic work, there is sufficient attention to external relationships and how they are going. He also thinks there could be more psychoanalytic attention to the connection with other relational health disciplines like family and group therapy.

Emde seemed to be saying that in the bad old days, the breakup of a marriage might have been interpreted as a displacement from the analysis or reflecting on the analysand’s symptoms in choosing an inappropriate partner. How, I wondered, might it be seen from the point of view that Emde advocates? Emde emphasizes that a research approach focuses on the questions to ask. A good analytic interpretation guides the patient toward a next step. The analyst should not close off exploration by pronouncing something a symptom, but rather guide the analysand to look further, including looking in directions like couples or family therapy, or looking at other resources. But “we’re not prescribing anything.”

Moral Development

Emde’s more recent work includes investigations of early moral development. He believes the psychoanalytic theory of moral development needs reworking. “Freud knew his metapsychology was a mythology, using metaphors to move toward a clinically relevant theory of the mind. There wasn’t a biology then to go along with it. Freud thought of metapsychology as a temporary thing. Now the biology, with advances in the neurosciences is either here, as per Mark Solms’s neuropsychoanalysis, or we’re on the frontiers of our knowledge of it…. That’s why, as a framing, a lot of the metapsychology in our field needs to be reworked and redone… and that’s particularly true in the theories of moral development.” Apropos of psychoanalysis, over the 25 years that Emde has been interested in moral development, he has observed a general shift in public discourse away from thinking of moral development predominately from within a rational framework. For example, everyday moral judgments are thought about in terms of “fast thinking,” and emotionally-based and intuitive judgments, as Daniel Kahneman and Amos Tversky have talked about them. The field of behavioral economics largely has to do with the emotionalirrational aspects of moral development. In a sense, this moves closer to the psychoanalytic view, but it involves a whole other non-conscious domain of mental functioning that is procedural or implicit and quick acting. And it involves emotion, different from Freud’s dynamic unconscious. Not only Freud, but Darwin had a lot to say about moral development, including topics like empathy whose development moves us toward some version of the golden rule. Similarly, Darwin noted our basic moral evolutionary basis for reciprocity and turn-taking behavior, relevant to elements of fairness.

There is also another aspect of moral development that Emde calls “valuation” which involves what Piaget talked about as cognitive assimilation, seeking out the new in order to make it familiar, a tendency Freud wrote about as mastery. Early on, the elements of valuation, and what seems right about the world are provided by inputs from parental caregiving. Today there is empirical data that these elements that lead to moral development are present from the beginning, postnatally, maybe even prenatally. “From the beginning, babies are social. And as part of that, there are these early features, dimensions of moral development.” He explained, we see in babies reciprocity and turn-taking behavior with parents, intentional and imitative, in movements with intimate interactions with parents and such as seen in videoed games of sticking out the tongue back and forth. Purposeful behavior can be seen in infants from the earliest weeks of life. Empathy, in the full sense of knowing that others have emotions separate from oneself is a later development. But early on there is emotional communication in the early minutes and hours of life between the baby and the mother. A lot of that has become evident as we no longer drug mothers during childbirth and at the same time make babies unresponsive. Mothers and babies are now looking at each other and communicating emotionally, pleasurably, as well as with the baby crying indicating that something needs to be changed. Moving into the second year of life, regular emotional communications and empathy become more evident. It can be shown that when mother shows distress, the toddler may not only evidence distress in responding but also show sharing, helping and caring behaviors.

Valuation is at root what Freud saw in his grandson’s Fort-Da game of separation and return, an attempt to master his mother’s being away. Emde and colleagues are developing what they refer to as the REV theory, R for reciprocity, E for emotional communication/empathy, and V for valuation. These are inborn processes developed in relation to the environment, caregivers, loving parents and attachment relationships. This research has not yet been integrated into psychoanalytic theory. It often focuses on the biology of early relationships and occurs in the context of attachment research, but Emde says, “remember attachment theory grew out of a psychoanalytic frame.” There is much work to be done, for example reformulating the Oedipus complex in these terms.

There is a dark side to many aspects of REV. The dark sides of reciprocity are retribution and retaliation. Empathy can involve manipulating people through understanding them as psychopaths and emerging tyrants do. And valuation includes categorization. The infant learns standards and rules that are contributed by culture through parenting, but also learns categories, the way things fit. Language and science include categorization. But in categorization, we also encounter the dark side of valuation with the tendencies for prejudice and premature formulation.

Scientific Attitude and Psychoanalysis

As we spoke, Emde often returned to the scientific attitude. “Part of science is always questioning, and a part of science is always sharing critical perspectives. As we know, psychoanalysis has major problems in this regard.” Regarding psychoanalysis and psychoanalytic training, Emde observes “institutions being closed off and not asking questions and not sharing and not having critical perspectives,” which risks making the field “less of a science and [may lead to its] disappearing ultimately as another cult.”

Emde talked about closed unscientific attitudes in terms of his own experience. I mentioned that his great paper “Development Terminable and Interminable” greatly influenced my thinking. When Emde gave it as a plenary at the IPA, he reviewed a lot of the then new attachment research. John Bowlby, whom Emde had not known previously, read the paper and was very interested in its ideas. The two then met. Emde said he was “fortunate enough” to chair a MacArthur Foundation research network on early developmental transitions. He convened a group for a workshop at what was then the newly named Anna Freud Centre; the topic was on story stem narratives in young children, research in which a story is started, and the child is asked to continue it. Attachment-related themes were included among the stories and Emde invited Bowlby to come. They met at his office in the Tavistock Clinic which was only four blocks away from the former Hampstead Clinic. “As I’m walking over with him, and just after as he crossed the main street that separated the two clinic areas, John Bowlby said to me, ‘You know, I’ve never been here. I’ve never been invited here.’“ The anecdote illustrates our institutional boundaries. Bowlby had been isolated for a long time as not being psychoanalytic enough, being too objective. This occurred in the context of the British Psychoanalytic Society’s well-known tensions between the A, B and C groups.

“At our meeting, there were story narratives presented from a child analytic case by a trainee, Peter Fonagy, who was on the verge of becoming one of our leaders in empirical psychoanalytic work, and who later integrated major parts of attachment theory into his work, expanding it in psychodynamic ways that hadn’t happened among the attachment work researchers.” This sort of cross-fertilization continued. For example, with Mary Main becoming interested in emotional availability, a construct from Margaret Mahler that Emde had extended with clinical and empirical work. Main sent one of her graduate students, Zeynep Biringen for a postdoctoral fellowship with Emde. Biringen in turn expanded attachment research beyond the range of maternal sensitivity and security to fundamental relational constructs that included a range of emotions beyond fear, with emotional availability scales that are now used widely to assess child-parent interactions from infancy to adolescence. She has also gone on to clinical training and expanded her developmental studies into intervention. Things like this can happen if we open the world of psychoanalysis.

Research and Psychoanalytic Education

Emde has made enormous contributions to educating researchers and educating analysts as researchers. I asked him about a hypothetical situation. An analyst reads his work on moral development, finds it fascinating and notices its relevance to his clinical work. He thinks he would like to contribute to that research. What would Emde recommend to such an analyst? How would he suggest the analyst become engaged? Emde responded, “The first thing I would do is endorse his passion that you just mentioned.” (I thought, always affect first.) He’d suggest connecting him with some people with similar interests, and ask about how it fit with where he wants to go and his career. He would want to “make sure we’re on the right page” and find a way he could start doing research, participate in it. He would want to connect him with groups of people who are willing to help, including researchers and clinicians. “They’re all over. And it’s exciting—the doors are open.”

Emde likes Serge Lebovici’s idea of psychoanalysis as a trans discipline, as integrative but multidisciplinary in outlook. He would suggest engaging in a research training program like the one founded by Peter Fonagy. Emde was fortunate to be on the ground floor with Fonagy in the early days and has participated ever since with the IPA’s summer research trainings. Linda Mayes’s program at Yale is another psychoanalytically oriented research training effort based on workshop programs. There are many researchers who are “particularly interested in helping young people and new people, not just young people in age but young to the field or young to the idea of research who are excited about doing it.” Emde is particularly interested in recruiting people with a developmental orientation. “I mean, I see a development window for everything, not just working with children and young children. People who have a developmental frame, as most researchers do, are positive people who want to share critical perspectives and who want to help and who are excited about things. There’s an excitement in the field.”

At the same time, Emde realizes research is not everyone’s cup of tea. Most analysts are clinicians. Emde believes “all researchers need to bear in mind the importance of clinical formulation. And I think all clinicians would be helped by having a research attitude.” The research attitude can be oriented around projects in which an idea develops into something workable, something that is observable. “And then you start doing your research. Hopefully you’ll do it with others.”

Most of the research training Emde has done has involved groups. Currently he participates in two or three groups for research training in different disciplines. All of these trainings are oriented around projects “because that really is the way things happen. You’re working on a project, and you’re working creatively with others.” Emde emphasizes sharing critical perspectives. “I have learned from colleagues everywhere, helping me along the way. The peer review process has been so important in my own work. You need critics to advance your research or it doesn’t go anywhere.”

Bob Emde has been part of a group that started 45 years ago and is ongoing. It’s a group for “critical sharing.” He and Joe Campos started it with a weekly meeting between their two research labs. They called it the “affect seminar” and it grew from there. Although Joe Campos left the group for UC-Berkeley and a career as a developmental psychologist, the group kept going, despite Emde’s attempts to stop it. Its meetings continued weekly for 30 years, more recently having dropped down to biweekly or occasionally monthly meetings. “It’s never been, I don’t think, mostly students in training, although we’re all students.

“Why does it keep going? It keeps going, and according to our interests; we share current, empirical, hot publications together. We share our critical perspectives. We choose current hot readings, usually from a major journal that we want to share our critical perspectives about. They’re current. And it’s the sharing process. No scientific work is ever perfect, obviously, … raising more questions than it answers. We need to share that because we all come from different backgrounds clinically and empirically as well as different disciplines. “The sharing is exciting. It keeps going because that’s how we learn, and that’s how we generate new ideas. And that’s extraordinary. And here I am at my age, 82, and it keeps going.” It’s now called the ASAP seminar, which stands for affect, stress and prevention. “We have a lot of stress intervention programs going on, and we’re interested in prevention. Prevention of psychopathology, prevention of illness of all kinds and the technology both with individuals clinically and communities that are prevention oriented….

“When you’re doing research, most of what you start out with, most of the ideas are wrong. most of your ideas, nine out of ten of them don’t work out…. But the most exciting things are the things you accidentally see, the serendipitous kinds of things…. If you like that kind of stuff, things light up.” Emde proudly went on to say that his postdoctoral and research mentoring have yielded eight or nine full professorships, not to mention clinicians and other academics. Mentoring—”that’s the thing I most enjoyed, I still enjoy.”

We had to wrap up our conversation, which took place via Zoom. Bob kindly said he loved to see my smiling face as we talked. This is quite a compliment from the world’s expert on smiling. But then affect is central.