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The Fundamentals of Psychoanalytic Technique

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A revised and updated edition of this recent classic, including new material on insight and early development, amongst others. Within each subject, the author presents the theories and observations of each major contributor to the particular topic, from Freud to contemporary thinking, and in the process shows the advantages and disadvantages of the various theoretical positions and orientations.

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PART ONE. Introduction to the problems of technique

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Psychoanalysis is a special form of psychotherapy, which itself first began to be a scientific discipline in nineteenth-century France, at which time two great schools of suggestion were developing— in Nancy with Liebeault and Bernheim and in the Salpetriere with Jean-Martin Charcot.

By what I have just said—and without wanting to review its history—I have located the birth of psychotherapy in the hypnotism of the nineteenth century. This assertion is open to discussion, but we will see that it also has important points of support. It is often claimed, and with good reason, that psychotherapy is an old art and a new science; it is this new science of psychotherapy that I place in the second half of the nineteenth century. The art of psychotherapy, on the other hand, has illustrious and very ancient antecedents, from Hippocrates to the Renaissance. Vives [1492-1540], Paracelsus [1493-1541] and Agrippa [1486-1535] initiated a great renewal, culminating with Johann Weyer [1515-1588]. These great thinkers, promoters of a first psychiatric revolution according to Zilboorg and Henry (1941), offer a natural explanation of the causes of mental illness but no concrete psychological treatment. Frieda Fromm-Reichmann (1950) sees Paracelsus as the father of psychotherapy, based at the same time—she says—on common sense and on an understanding of human nature. But, if this were the case, then we would be confronted with an isolated fact in the historical process; because of this I prefer to place Paracelsus among the precursors and not among the creators of scientific psychotherapy. Reasoning as Frieda Fromm-Reichmann does, we could cast Vives, Agrippa and Weyer as fathers of psychotherapy.

 

PART TWO. On transference and countertransference

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The theory of transference, one of Freud’s major contributions to science, is also the pillar of psychoanalytic treatment. In reviewing the works in which the concept makes its appearance and those covering its total development, one is struck by the brevity of this time period— as though the theory of transference had arisen all at once and in its entirety in Freud’s mind, although the opposite has always been claimed, namely, that he elaborated on it bit by bit. Nevertheless, it is possible that these two assertions are not contradictory, if the former refers to what is central in the theory and the latter to its details.

A recent re-reading of “The Concept of Transference” by Thomas Szasz (1963) made me reconsider this little dilemma, which is surely interesting from the point of view of the history of psychoanalytic ideas. As we all know thanks to Jones (1953-57, Vol. 2) and to Strachey’s “Introduction” (1955) to Freud and Breuer’s great work, Studies on Hysteria (1895d, pp. ix-xxviii), Anna O’s treatment took place between 1880 and 1882 and ended with an intense transference and countertransference love—and, one might even say, para-transference, due to the jealousy of Breuer’s wife. The three protagonists in this little sentimental drama registered it as a human episode similar to any other. Towards the end of 1882 (the treatment had ended in June of that year), Breuer commented to Freud on this traumatic outcome; but it seems that Freud also did not at first associate the state of falling in love with the therapy. When, a little later, Freud commented on this situation in a letter to Martha Bernays, then his fiancee, he reassured her, saying that this would never happen to him because “for that to happen one has to be a Breuer” (Szasz, 1963, p. 439).

 

PART THREE. On interpretation and other instruments

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The main part of the studies we are about to begin consists in the study of interpretation, the foundation of psychoanalytic therapy. Nevertheless, no one maintains that the analyst’s activity is strictly limited to interpretation, and we always do more than this. In a more inclusive sense, then, what we are going to study are the instruments of psychotherapy, among which interpretation occupies the central place. At the same time, we should take into account that interpretation is not exclusive to psychoanalysis, as it is used in all the major forms of psychotherapy.

Thus it is necessary to begin by placing interpretation within the context of the complete set of instruments the psychotherapist should work with, and explain why this instrument has a special importance. In addition, we must delimit the concept of interpretation, because depending on whether we adopt a wide or a narrow meaning, we will arrive at different conclusions as to the analyst’s task, as to whether he only interprets or does other things. At times this is simply a problem of definition. Logically, if a very wide meaning is assigned to it, everything can be called interpretation; but perhaps this is not the best criterion.

 

PART FOUR. On the nature of the psychoanalytic process

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We must now look into a complex and attractive theme, the psychoanalytic process. This is something that awakens the enthusiasm and even the impassioned interest of analysts, and so it should be. If the study of the technique has a fundamental objective, it can be none other than that of contributing to each analyst’s acquisition of his style and his analytic being, of his identity. The latter depends on the congruence between what he thinks and what he does, which derives in good part from how the psychoanalytic process is understood. An analyst who minks in a way that is coherent with what he does, although his scheme of reference may not be to my liking, will always be preferable to one who thinks as I do and not as he (in fact) does.

I refer to the analytic process in broad and intentionally imprecise terms in order to cover the totality of issues we will study. However, if we wish to be rigorous, what we must first do is to distinguish the process from the analytic situation.

The practical analyst uses these two terms, “situation” and “process”, with sufficient precision. He rarely commits errors in using them, since they are sanctioned by ordinary language. We will say, for example, that the analytic situation has become stabilized or complicated, and mat the process continues or has been arrested—never the other way around. Nevertheless, when we try to conceptualize what is easy for us to distinguish, we encounter difficulties.

 

PART FIVE. On the stages of analysis

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In part 4 of this book we studied in some detail the nature of the analytic process. We began by distinguishing situation and process. We then reviewed the principal theories that try to explain it, with which we had to consider multiple and sometimes divergent—if not opposing— points of view.

Now we have a less complex task, on a lower theoretical level, which is nonetheless interesting, and it is to typify the stages of analysis. As we examine them, the reader will verify their practical importance, no less than the support the previous arduous study provides in their understanding.

To begin this chapter, we must pose a prior problem, and it is whether stages in analytic treatment really exist—because they may not exist. In fact, most writers think they do; I do not know whether some doubt this, but the discussion—however brief—is in any case pertinent. A stage in this context means that in the evolution of the psychoanalytic process there are characteristic, definite moments, different from the rest, with special dynamics that distinguish them.

 

PART SIX. On the vicissitudes of the psychoanalytic process

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If the psychoanalytic process aims to achieve insight, then insight constitutes by definition the backbone of the psychoanalytic process. This idea is not polemical in itself, because most analysts accept it; on the other hand, there is controversy about whether there are other factors that, together with insight, determine the course of the process. Here there is certainly a basic problem that we will not study at this point; but it is necessary to note that, at times, discrepancies arise from the scope accorded to the terms in question.

Nacht (1962, 1971; Nacht et al., 1958) can question the neutral attitude of classic technique and contrast it with what he calls the analyst’s presence, but he does not doubt the function of insight, as can be seen in his account at the Edinburgh Congress of 1961. In any case, and as opposed to Nacht, it is generally thought that insight is achieved basically through psychoanalytic interpretation, although some argue that it can also be achieved through other methods. A man as meticulous as Bibring (1954), for example, says that insight is achieved not only through interpretation but also through clarification, although this is again a problem of definition. As Wallerstein (1979) says, it is easier to state it than to distinguish it in practice.

 

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