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The Psychoanalytical Process

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Sets forth an integrated concept of the 'natural history' of the psychoanalytical process, viewed in the light of experience gained in the child-analytical playroom, and applied to the more complicated phenomena of adult patients.

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10 Chapters

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1. The Gathering of the Transference

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Children approach analysis, as they do any new experience in life, under the guidance and authority of their parents. It has been the custom to think that the wish to please parents, the hope for gratification of secret yearnings, and the expectation of relief for current distress were mingled in varying degrees to propel them toward the new experience, while anxieties held them back. Alternatively one might think that the motivational pattern is more completely unconscious and belongs to a general category of the wish to maintain the status quo versus the drive toward integration. I do not think that these two points of view are by any means incompatible but I find the latter more in keeping with my experience and my way of describing analytic phenomena.

From this viewpoint a child's life at the inception of analysis would appear to be full to overflowing with objects in the outside world – parents, siblings, relatives, servants, teachers, pets, toys, machines and nature generally. While his tendency, impelled by various drives and anxieties, is to extend the boundaries of self and to engulf every new object, he also suffers from a fear of over-extension – of ‘getting lost’ in fact, and for this reason attempts to maintain a defined perimeter. The geography of this perimeter, as regards the outside world, is primarily, as in so many games, defined as the emotional distance from ‘home’, which is the domicile, truly, but of course fundamentally the bodies of his parents, especially mother. Thus persons and things possess a valence of positive and negative as they are felt to be friendly to the parents, the intensity of the valence varying with the degree of intimacy, friendly or hostile. It is for this reason that a phobia, for instance, will almost always be found to have a link with a parental phobic trend. On the other hand we know that an oedipal negative valence arises the moment a too-positive intimacy with a parental figure is suspected.

 

2. The Sorting of Geographical Confusions

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In the first chapter I have described my experience of the initial phase of the analytic process with children, carrying as a central thesis the contention that this process has a natural history of its own, determined by the structure of the mental apparatus at deeply unconscious levels. If this process is adequately presided over by the analyst through the creation of an adequate setting and through an interpretive intervention sufficiently correct and timely to modify the severest anxieties and to facilitate working-through, a sequence of phases can be seen (in retrospect mainly) to have emerged, the second of which I wish now to illustrate.

The first weekend separation sets in train a modality of relationship at deep levels of the unconscious which is increased in intensity as the infantile transference processes are gathered and brought to bear in the analysis. This modality, or the trend toward it, is released by every regular separation experience and, later in analysis, will be revived by every unplanned break in the analytic continuity. The modality to which I refer is the infantile tendency to massive projective identification with external, and soon also with internal, objects. It arises from a configuration of motives and gives rise to a spectrum of consequences which need detailed examination. First, however, a general economic principle should be clarified. The duration of the phase dominated by any particular transference organisation is not really predictable at present, as the factors governing mobility of defences, the intensity of the drive toward integration, the capacity to accept dependence, etc., are all at present obscure and are ordinarily put together under the rubric of ‘constitutional’, which, whatever its biological reference, in practice probably means that we can only assess them in retrospect but not in prospect. In the second place, the term ‘dominate the transference’ must also be taken as a relative one, since the economics of that disposition is obscure. The analytic process is a cyclical one, and the phases which I trace here in a panoramic way can to some degree be seen to appear in sequence in every session, every week, every term, every year – that is, in all four of the cyclical time units of the analytic process. The phase under discussion, being concerned with the experience of separation and of separate identity, naturally tends more to dominate the beginning and end of such cycles – session, week, term, year. But one can reasonably say that the analysis itself is being ‘dominated’ by this dynamism as long as it occupies an overwhelming portion of the analytic time and until the anxieties with which it is concerned have been elucidated so that the working-through can commence. It is probably a correct view that this working-through never completely ceases, which is only another way of saying that the struggle against regression and disintegration is continual.

 

3. The Sorting of Zonal Confusions

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In the first two chapters I have traced the early phases of the analytic process, first the gathering of the transference processes into the treatment, and second the differentiation of self and object which is brought about by the systematic investigation of the operation of massive projective identification, as it is intensified in the transference in relation to separation. It seems clear that, since massive projective identification can function to counter any configuration producing psychic pain at infantile levels, no other problem can really be worked through until this mechanism has been to some considerable degree abandoned. In the neurotic patient this may be accomplished in a matter of months or a year of analysis, but in borderline and psychotic patients it is the major work, taking years – and its accomplishment represents an analytic achievement of the first order. In fact, as I have said it would probably be called the crucial step in establishing fundamental health and removing the danger of psychotic deterioration.

 

4. The Threshold of the Depressive Position

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In the first three chapters I have described my tentative reconstruction of the natural history of the analytic process, a sequence dictated by the economics of psychic life, as it unfolds in analysis when adequately presided over and adequately supported by environmental factors outside the analysis proper. It is important to bear in mind that this whole concept of the natural history of the analytic process cannot be used in the moment-to-moment work of the consulting room. It is not a tactical conception but a strategic one, which, like W. R. Bion's Grid (1964), is for use in mobilising and preserving the therapeutic vitality of the analyst. Perhaps it is also of use in the retrospection which is required for the making of scientific communications.

It has been described how the gathering together of infantile transference tendencies makes possible a systematic clarification of confusional states, in the course of which there takes place a relinquishment of narcissism (as a principle of organisation) in favour of dependence on internal primal good objects (and externally, the analyst and analytic setting and process). I have emphasised that the growth of actual dependence and the growth of its acknowledgement proceed independently, the projective relation to the mother (toilet-breast) being more easily established than the introjective (feeding-breast) which we are about to study. This in turn is more easily accepted than the necessary role of the paternal penis. This conflict, the Oedipus complex, at genital and pregenital levels, forms the core of that striving for integration and independence, which we will study in the next chapter.

 

5. The Weaning Process

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As mentioned in the previous chapter, when the feeding relation to the breast at infantile levels begins to be acknowledged in the experience of the transference, termination immediately looms on the horizon and the fear of premature ending plays a role in all the subsequent work. This fear interacts at infantile levels with the depressive concern for ‘mother's babies’ and dominates the struggle toward integration as a life-long task. Its counterpart at the most adult level arises as an aesthetic and intellectual appreciation of the analytic process even in young children, driving the patient to ‘give the next fellow his turn’ and to spare the analyst unnecessary work – the ‘time of his life’.

This latter point, being the main focus of the therapeutic alliance in approaching cooperatively the decision for termination, may occupy us first so that we can return to the infantile problems in a more organised way. By the time that this phase has been reached in analysis, even with young children: the cooperation and interest in the analytic work is astonishing: not only embracing control of acting out and a continual collection of material for analysis from the events of daily life: but an enthusiasm for dream analysis which comes from the full acknowledgement of psychic reality and its primacy for their states of mind. The repeated experience of awakening from sleep in a mood which cannot be shaken off until the analytic session resolves it, brings forth both conviction and gratitude which sets in motion the urge to self-analysis out of useful sparing motives, in contrast to the envious or competitive motivation which was the driving force in such pseudo-self. analytic attempts during phases two and four in particular.

 

6. The Process with Adult Patients

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It was thought better to leave the discussion of the similarities and differences between adult and child analysis until our observations on the analytical process with children had been laid before the reader, trusting that preconceptions in his mind would not prevent his persevering even if he lacks experience of child analysis. Perhaps no better way of introducing a discussion of this present topic could be found than case material dealing with the transition of method with pubertal children. Anyone who has started an analysis with a pubertal or adolescent child knows how long it takes before a psychotherapeutic process gives way to a truly analytical one. The analyst is confronted with all the limitations of child analysis regarding motivation and responsibility, without the advantages of play technique with its naivety of communication.

It is a quite different situation with a child who has been in analysis for some years of the latency period and in this context meets the mental and physical changes of puberty. At such a time we can see suspended before our eyes the two techniques, in oscillation and in competition with one another.

 

7. The Cycle of the Process in the Individual Sessions

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It seems likely that the findings presented in this volume came as much from the experience of supervising students and colleagues as from the immediate encounters of the consulting room. A description of the technique of supervision which I employ may help to orientate the reader to the presentations of this chapter. My emphasis is always on the material of the session which I ask supervisees to read to me, commenting and elaborating on their notes freely, stopping the flow as soon as I feel I would have interpreted, usually prior to the supervisee's report of his interpretation. I am in the habit, with new cases, of working without background material, asking initially only the age, sex, number of siblings, marital status, number of children, whether parents are alive, occupation and chief complaint. Of course with cases presented over a period of months a considerable filling-in takes place, but always my emphasis is on the immediacy of the analytic situation, including aspects of the setting, while I leave problems of counter-transference aside as private to the supervisee.

 

8. The Analytical Work

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One cannot suppose that material such as that in Chapter 7 can be convincing in regard to details of the formulation, yet it is illustrative of the modes of thought and methods of work in the group whereby the in-breeding of thought and expression give rise to a homogeneity of outlook which cannot avoid being idiosyncratic in its superficial aspects. But it will be seen to illustrate the points which we must now examine in detail in our investigation of the nature of the analytic work. In a certain sense all of this book is dedicated to the thesis that the major work of analysis is done in the unconscious of the patient whence the ‘natural history’ of the analytic process emanates. The analyst's contribution, on the other hand, is of two sorts: the creation and maintenance of the setting within which the analytic process, the evolution of the transference, can take place, and secondly, in creating that aspect of the interpretive process which at various points facilitates the passing of certain obstacles to this evolution as well as, by the building up of insight, bulwarks the personality of the patient against regression. As these two functions appear to be fundamentally distinct, they may usefully be dealt with separately in terms of (a) the setting and (b) the working through.

 

9. Psychoanalysis as a Human Activity

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Freud's early sanguine assumption that anyone who could learn to analyse his own dreams could practise analysis has progressed to its own antipodes. We now must ask the serious question how anyone can practise analysis without being damaged. Of course every occupation has its special hazards, so no complaint is allowable. Rather it is necessary to look with a sober glance at the hazards of psychoanalytic work, construe and test the safety measures and prophylactic schemes.

No doubt in its own way the so-called training analysis has been the bastion of self-defence of the analyst against the rigours of analytic work and will continue to be so, most realistically when it is continued in a systematic way as a self-analysis. The second rampart has been the analytic method, the faithful pursuit of which has been the psychoanalyst's best defence against being lured into ambush of counter-transference activities, the harbinger of which is almost always the breach in technique.

Probably neither of these preparatory schemes can continue to function effectively for the practising analyst without the scientific society of other analysts, at seminars and scientific meetings, supervisions and congresses. The history of analysis in the future is not likely to include the lone pioneer bringing this discipline to new areas of the earth. It will almost certainly be possible only as group efforts. What part the published literature plays in all this is still, I believe, obscure. Certainly only the intellectual outlines of a scientific advance in our field is communicable in writing, except to the rare individual with first-rate literary talent, such as Freud.

 

Appendices A–L

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As explained in the Introduction, this book has grown in the milieu of lectures, seminars and supervisions, to some extent separated from the clinical work from which theoretical contributions to psychoanalytic literature derive. As a consequence a certain asynchrony is sometimes evident in the text in that reference is made to theoretical ideas which have not as yet taken their place in the literature.

In the following section these ideas and areas of development will be expanded, as a holding method, until future publications can give them more definition.

Appendix A: Acting-out and acting-in the transference

These problems of analytic method and process are of special interest from the structural point of view and will be dealt with extensively by Dr Herbert Rosenfeld in a future publication, which will carry forward the work begun in his paper, ‘An investigation of the need of neurotic and psychotic patients to act out during analysis’ (in Psychotic States, 1964).

 

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