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The Technique and Practice of Psychoanalysis

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This systematic and comprehensive volume, written in a lively and clear style, is devoted essentially to the fundamentals of psychoanalytic technique: transference and resistance. Dr. Greenson approaches psychoanalytic technique from a classical theoretical framework, but he frequently gives an entirely fresh view of traditionally accepted procedures. His most important new contribution consists in the clear distinction between the patient's 'real relationship' to the analyst, the 'working alliance', and the transference relationship. His discussion of the contradictory and often conflicting demands which each of these elements makes on the technical skills of the analyst is particularly illuminating. In many fascinating case illustrations, he shows how the analyst carries out therapeutic psychoanalysis while respecting the diversity of psychic constellations in different patients and at different points in their analyses. This book can be recommended - without qualification - to the beginning student because of the thorough clarification and documentation of the basic principles of psychoanalytic technique. At the same time, experienced analysts and teachers will appreciate and be stimulated by Dr. Greenson's open-minded discussion of some unsolved problems and issues in psycho-analytic practice.

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Chapter 1: Survey of Basic Concepts

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1.1 The Historical Development of Psychoanalytic Therapy

ONE way of ascertaining what is essential in psychoanalytic therapy is to take a bird's-eye view of its historical development and to note the major changes in the technical procedures and in the therapeutic processes. What follows is a selective summary of the highlights of Freud's writings on these matters. A more detailed investigation of each subject, including the contributions of others, will be found in the appropriate place in the text that follows.

Let me clarify the terminology. I am using the term technical procedure to refer to a measure, a tool, a course of action, an instrumentality, undertaken by the therapist or the patient, with the purpose of furthering the therapeutic processes. Hypnosis, suggestion, free association, and interpretation are examples of technical procedures. A therapeutic process refers to an interrelated series of psychic events within the patient, a continuity of psychic forces and acts which have a remedial aim or effect. They are usually instigated by the technical procedures. Abreaction, recapturing memories, and insight are therapeutic processes. (See E. Bibring [1954] for a similar but more comprehensive methodological approach.)

 

Chapter 2: Resistance

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IHAVE selected the subject of resistance as the first technical chapter of this book because it was Freud's discovery of the importance of analyzing resistances that ushered in the beginning of psychoanalysis and psychoanalytic technique (Breuer and Freud, 1893-95, pp. 268-270; Freud, 1914c, p. 147; Jones, 1953, p. 284). The handling of resistances has remained one of the two cornerstones of psychoanalytic technique.

Psychoanalysis can be differentiated from all other forms of psychotherapy in the way in which it deals with resistances. Some methods of treatment aim at strengthening the resistances; they are designated as the “covering-up” or “supportive” therapies (Knight, 1952). Other varieties of psychotherapy may attempt to overcome resistances, or evade resistances in different ways; for example, by suggestion or exhortation, or by exploiting the transference relationship, or by using drugs. It is only in psychoanalytic therapy that we attempt to overcome resistances by analyzing them, by uncovering and interpreting their causes, purposes, modes, and histories.

 

Chapter 3: Transference

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THE development of the technique of psychoanalysis has been determined essentially by the evolution of our knowledge about the nature of transference. The greatest advances in psychoanalytic technique were derived from Freud's (1905c) major discoveries about the twofold power of transference; it is an instrument of irreplaceable value, and it is the source of the greatest dangers. Transference reactions offer the analyst an invaluable opportunity to explore the inaccessible past and the unconscious (Freud, 1912a, p. 108). Transference also stirs up resistances that become the most serious obstacle to our work (p. 101). Every definition of psychoanalytic technique must include as a central element the analysis of the transference. Every deviant school of psychoanalysis can be described by some aberration in the way the transference situation is handled. Transference reactions occur in all patients undergoing psychotherapy. Psychoanalysis is distinguished from all other therapies by the way it promotes the development of the transference reactions and how it attempts systematically to analyze transference phenomena.

 

Chapter 4: The Psychoanalytic Situation

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AFTER having discussed the analysis of resistance and transference, it would seem to be in order to take the psychoanalytic situation as our focal point. The analysis of the psychoanalytic situation offers us an opportunity to re-examine many of the procedures and processes we have already described from a different vantage point. By converging on the interrelationship of patient, analyst, and setting, we may gain additional insight into the unique power of the psychoanalytic situation as a therapeutic instrumentality. Furthermore, it may provide us with another occasion to clarify the complicated interactions among the three essential elements: patient, analyst, and setting. Although their relationship is an interconnected and interdependent one, it is advisable to explore separately each of the three components which constitute the psychoanalytic situation. We shall then ask ourselves: what does each contribute and how does each influence the psychoanalytic situation? (Stone's [1961] book on the subject is suggested as the most comprehensive reference source.)

 

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