The Practice of Psychoanalysis

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This volume highlights several of the areas of tension and difficulty that have met psychoanalysis since its inception, and provides an incisive, informative history of various attempts to surmount these, finally leading to the author's own suggestions for a practice of psychoanalysis that remains open to the vicissitudes of the infinite set of processes of the human mind. In drawing from clinical examples and his own experience in addition to a wealth of psychoanalytic theory, the author examines such topics as the referential role of theory and the significance of the analytic space from both a personal and professional standpoint. As the author suggests, the dialectic between psychoanalytic theory and practice is one that is both highly problematic and potentially very nourishing. Thierry Bokanowski's volume provides an invaluable guide to analysts navigating the difficult terrain of contemporary psychoanalytic theory and practice.

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CHAPTER ONE. Method and practice

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The practice of psychoanalysis derives in the main from the teachings of its founder. Freud was the first to discover the universal nature of the laws that govern the workings of the unconscious, and analysis came quite rapidly to be defined, in practice, as being linked to the transference and the experience of the transference relationship. The therapeutic dimension was attributed to the application of a specifically psychoanalytic approach based on the transference relationship and its interpretation, and its sole justification was seen to be the underlying theory that both explained how it functioned and made it meaningful.

Freud, transference, and the practice of psychoanalysis

In the early days, when the psychoanalytic approach was first being developed, Freud drew up a number of guidelines and technical rules that were to become the mainstay of analytic practice. The validity of these concepts, developed over less than twenty years (1895-1915), has never since been called into question: on the analysand’s side, to respect the fundamental rule (free association and reporting of dreams), and on the analyst’s, the setting (the couch-and-armchair “space”, regular and frequent sessions of fixed length).

 

CHAPTER TWO. Concepts in contemporary psychoanalytic practice

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There is at present a considerable number of techniques that claim to be able to cure mental suffering and even pride themselves on that fact—hypnosis, Gestalt therapy, Dasein therapy, transactional analysis, micro-psychoanalysis, primal scream, re-birthing, non-analytic relaxation, cognitive and behavioural psychotherapies, etc., to name but a few.

On what grounds can we argue that there exists a crucial difference between psychoanalysis as we know it and these other techniques that all claim to be psychotherapeutic? Unlike any of these, psychoanalysis is the only psychotherapeutic method that, after recognizing the fundamental significance of the Unconscious in the organization of the human mind, invented a specific technique for investigating that Unconscious and its manifest expressions with the help of the conscious and interactive part of the individual. The technique is based on the tendency to repeat inherent in all mental processes, as well as on an essential feature of the instinctual drives: the opportunity to displace cathexes on to new objects.

 

CHAPTER THREE. The work of psychoanalysis

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Even though the practice of analysis, as it presents itself to our thinking, with its objects and its elements, is rich in contrasts and contradictions—apparently, at any rate—we cannot completely ignore the demands imposed by our concern for consistency in practice and for coherence in psychoanalytic theory. We have no choice but to admit that, in so far as the practice of analysis can be identified as such, a common set of values precedes any explicitly individual value system. It is necessary, therefore, for analysts to be able to share some representation of the psychoanalytic process and its theoretical and practical implications. In spite of its diversity—some would say over and beyond its diversity— the work of psychoanalysis is organized and developed around a certain number of parameters that define its specificity.

The analytic space

The analytic space is the locus par excellence, saturated in affect, that allows the transference to unfold and the transference neurosis to develop and be analysed. Thus, an essential feature of the analytic space is that the dynamics of the process that develops therein are structured around the encounter between two imaginary dimensions that, in each participant, set up resistances: in the patient, the unfolding of the transference and the development of the transference neurosis, in the analyst, via the countertransfer-ence. The affects aroused by the transference neurosis and those involved in the analyst’s countertransference, though different in structure, dynamics, and intensity, contribute to the organization of the analytic space, the domain that makes possible the development of the psychoanalytic process.

 

CHAPTER FOUR. Clinical matters

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In this chapter I report on three clinical cases that illustrate how transformations can occur in the patient’s mind in the course of the psychoanalytic process and the work of the analysis.

With the first of these cases, I try to clarify how the work of the analysis can enable a patient to transform mental impulses, in particular through the analysis of the resistances relating to negative transference, and change how regression and repetition operate.

The short extract from the second analysis involves a particular kind of countertransference movement in the psychoanalyst when a traumatic event occurred in the patient’s life that revived memories of earlier trauma in her past history.

The third analysis highlights the work of linking, un-linking and re-linking that the analyst has to accomplish when a patient finds him- or herself at a dead end as regards the capacity for representation. This dead-end emerges when the transference relationship unfolds without a sufficiently strong protective shield against stimuli, thereby giving rise to an overwhelming degree of eroti-cization.

 

CHAPTER FIVE. The sexual sphere and the work of the analysis

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I The Devil religion

Freud freely admitted that, though he felt considerable admiration for the great Russian writer Fiodor Dostoevsky, he did not care much for his personality. In a letter to Theodor Reik dated 14 April 1929, Freud wrote:

You are right, too, in suspecting that, in spite of all my admiration for Dostoevsky’s intensity and pre-eminence, I do not really like him. That is because my patience with pathological natures is exhausted in analysis. In art and life I am intolerant of them. Those are character traits personal to me and not binding on others. [Reik, 1940, quoted in Freud, 1928b, p. 196]

In his paper on Dostoevsky and parricide, Freud (1928b) stresses the fact that Dostoevsky was “[a] neurotic, [a] moralist and [a] sinner” (ibid., p. 177). For Freud, these three epithets were enough to summarize the whole personality of the Russian writer; he used them to paint an extraordinary psychological portrait of Dostoevsky that brought together the latter’s epilepsy (with the hypothesis that it was hysterical in origin), his moral masochism, and his strong bisexual tendencies (latent homosexuality and the negative form of the Oedipus complex) in an attempt to explore and to analyse the theme of parricide:

 

CHAPTER SIX. “Analysis terminable and interminable”—refusing the feminine dimension

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Refusing the feminine dimension

What metapsychological interpretation could nowadays be given to Freud’s metaphor of the “underlying bedrock” linked to refusing the feminine dimension or, as he himself put it (Freud, 1937c, p. 250), the repudiation of femininity? After Freud, who saw in the repudiation of femininity in both sexes a bedrock, some French psychoanalysts have made their own contribution to that interpretation. Green, for example, sees in it an expression of the horror of being made to adopt a passive position, linked in the mind to “primary maternal madness” and to the mother’s femininity; the latter has to be rejected at all costs because of the fact that it tends to produce passivity (Green, 1975, p. 62; 1990, p. 186). Fain sees in it a defensive manoeuvre aimed at containing the imago of a destructive mother endowed with the power to put to death (Fain, 1987, p. 18). For Guignard (1997), rejecting the feminine dimension implies that representations of maternal sexuality have to be pushed as far as possible into the background, and, for Schaeffer (1997), repudiating the feminine sphere is an expression of the ego’s resistance as regards submitting to the constant thrust of the sexual drives and thereby allowing great quantities of de-fused libidinal excitation to emerge.

 

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