Medium 9781782200567

Theory of Psychoanalytical Practice

Views: 1506
Ratings: (0)

This book makes an original contribution to the study of the psychoanalytic process from a relational point of view, and at the same time serves as a textbook on the theory of technique. It provides a general exposition of the theory of psychoanalytic practice from a process perspective that emphasizes the analytic relationship, the dyadic nature of the psychoanalytic situation, and the impact of unconscious interaction between its two parties, and also includes the authors personal point of view and contributions on the subject.

List price: $30.99

Your Price: $24.79

You Save: 20%

Remix
Remove
 

12 Chapters

Format Buy Remix

Chapter One - Introduction

ePub

CHAPTER ONE

Introduction

This text is an attempt to develop an integrative view of the theory of psychoanalytic practice. It is not, however, a theory of classical technique, but of a particular approach to clinical practice: that of relational psychoanalysis. Such view of our discipline is at odds with the traditional Freudian conception and with many of the prevailing schools in contemporary psychoanalysis. Nevertheless, it corresponds with the feelings and practice of many analysts, who have been trained in the various psychoanalytic traditions, but who have gradually found that their clinical experiences have led them to depart from some of the most cherished and adamantly sustained beliefs of their colleagues and friends. This new understanding of the nature and means of our work had been steadily unfolding in various areas of the psychoanalytic world, but until very recently it lacked a name that helped us to identify what the many clinical and theoretical contributions had in common. So, the various writers or groups developed their own terminology and concepts in order to account for their experience and practice. This tended to obscure the fact that they were unwittingly a part of an evolving collective movement.

 

Chapter Two - The Psychoanalytic Situation

ePub

CHAPTER TWO

The psychoanalytic situation

The early evolution of technique

The early evolution of psychoanalytic technique is well known. At first, Freud used suppressive hypnosis for the treatment of neurotic symptoms. This implied giving the patient repeated commands that the symptom should disappear. In his 1893 paper “A case of successful treatment by hypnotism” (1892–1893), however, he introduced an interesting technical modification. He was then treating a young woman who had an obvious aversion to suckling her baby, rejected nourishment, and repeatedly vomited when forced to eat. After his initial injunctions met with a partial success, which was readily down-played by the patient's family, Freud decided to try another strategy. Thus, he suggested to her that, five minutes after he left, she should face her family, rather violently, and demand of them why they were not giving her anything for supper, whether they were set on starving her, how on earth did they expect her to nurse her baby, and so on. From that moment on, her symptoms magically disappeared, although her husband was distressed by the fact that his wife had unwontedly expressed bitter reproaches against her mother. Obviously, the therapist had somehow sensed the existence of a family conflict and induced the patient to display it openly, instead of disguising it as a symptom. Not surprisingly, the family was not at all pleased with the treatment, in spite of the good therapeutic results! As could be expected, the relief was only temporary and Freud had to be called again after one year, when the birth of a new baby rekindled the problem.

 

Chapter Three - The Analytic Attitude

ePub

CHAPTER THREE

The analytic attitude

The analyst's contribution to the analytic situation

In the previous chapter, I have made a case in favour of considering the analytic situation as an instance of interaction—both conscious and unconscious—between analyst and patient. Now, “interaction” means “mutual or reciprocal action or influence”. This represents a serious questioning of the usual allegation that “there is no room for action in psychoanalysis”. It also implies that the analyst's participation in the analytic situation goes far beyond his or her conscious and purposeful technical interventions.

Such contentions are inevitably disquieting for analysts and patients alike, since they suggest that the former might not be in full control of the situation while conducting an analysis. But, if there is any chance that this might be true, we should confront it, try to understand it, and benefit from the ensuing knowledge.

From this point of view, the analyst contributes to the analytic situation in three different but interrelated ways. In the first place, there is the mutual interaction, which is mainly unconscious, that is set in motion whenever two people meet in any given situation. In this, psychoanalysis is no different from any other relationship.

 

Chapter Four - The Context of Analysis

ePub

CHAPTER FOUR

The context of analysis

What is a context?

The concept of “context” is not a part of psychoanalytic theory. None the less, we are constantly unwittingly referring to the context of the patient's expressions, since no human communication can be understood without it.

A context is that set of subsidiary information about a text that helps the reader to determine the meaning or meanings that may be found in it. Such information may be of various kinds. For instance, the passages that precede or follow a certain portion of the text might shed light on the meaning intended by the author. The reader may also use some external information about the circumstances in which the piece was written—such as the author's personality and biography, the intended audience, and the social and political environment at the time. But the reader-interpreter might go even further, and attempt to discover meanings that had never been conscious for the author, but that may be plausibly inferred from the juxtaposition of the text and its context.

 

Chapter Five - The Substratum of Analysis

ePub

CHAPTER FIVE

The substratum of analysis

The analytic relationship and experience

The analytic situation may be viewed in terms of several components: (a) the context of analysis, provided by the setting and the contract; (b) the analytic process, represented both by the verbal, non-verbal, and emotional interchanges that take place between both parties; (c) the substratum of analysis, on which the process is founded. The latter is the analytic relationship.

Everything that happens in an analysis is rooted on the analytic relationship and without it there is no analysis. Interpretation, for instance, is not only information that the patient receives about herself—or, rather, about what the analyst thinks about her—but also, and foremost, a particular form of relationship with another human being.

Freud (1913c) clearly realised the importance of this relational basis for interpretation and insight. In his paper “On beginning the treatment”, he posed the question about which is the right moment to begin the analyst's communications to the patient, and his answer was definite:

 

Chapter Six - The Analytic Field

ePub

CHAPTER SIX

The analytic field

The concept of “field

In the early 1960s, the Barangers published a paper in Spanish titled “The analytic situation as a dynamic field” (Baranger, & Baranger, 1961–1962), which was published in English only in 2008. There, they claimed that the analytic situation should always be understood as a two-person setup, in which neither party may be conceived without the other, since they are inescapably bound and complementary. This they called a “dynamic field”.

The concept of “field” was first used in science by physicists, who used it to refer to a region of space in which a given effect (such as magnetism or gravity) exists. But it also implied a certain organisation of such a region, in which any change at a given point had effects on every other point of the field. Field theories implied an epistemological revolution in science, since they replaced linear causality, as an explanatory principle, by complex interdependence. They also had the characteristic of being atemporal, since they explained the phenomena that took place in the field in terms of its organisation and dynamics, without any reference to its previous history.

 

Chapter Seven - The Analytic Process

ePub

CHAPTER SEVEN

The analytic process

The concept of process

Both the concept of field and that of process constitute attempts to describe and conceptualise the non-personal (and, hence, non-interpersonal) aspects of the analytic interaction. This is what we might call the transpersonal dimension of the analytic treatment. If we look at a psychoanalytic session with the eyes of ordinary consciousness and common sense, it is obvious that there are two people in the room, that the latter is a consulting room, and that they are there to engage in a sophisticated interchange, framed in terms of a service contract aimed at restoring what is considered to be one party's “mental health”. Such is the manifest content of the experience, but what about its underlying unconscious dimension? Bion (1980) approached this problem in the following terms:

Every psychoanalyst has to have the temerity, and the fortitude which goes with it, to insist on the right to be himself and to have his own opinion about this strange experience which he has when he is aware that there is another person in the room. Pressure against it is considerable: your senses tell you that it is your office; you are used to the windows here, the furniture there; there is every pressure to make you feel you are at home. It is difficult to resist that. I have suggested this: Discard your memory; discard the future tense of your desire; forget them both, both what you knew and what you want, to leave space for a new idea. A thought, an idea unclaimed, may be floating around the room searching for a home. Amongst these may be one of your own which seems to turn up from your insides, or one from outside yourself, namely, from the patient. (p. 11, my italics)

 

Chapter Eight - The Dimensions of the Process

ePub

CHAPTER EIGHT

The dimensions of the process

The golden braid

The very idea of the psychoanalytic process, framed in these terms, implies a goal-directed evolution that is set in motion by the encounter of these two human beings, which has a development of its own, quite apart from the conscious intentions and will of the two parties. Of course, any relationship between human beings initiates an unconscious process, so what is it that defines a bipersonal process as “psychoanalytic”? There is the initial intention and agreement about a shared goal and the way in which they are going to try to attain it, and a general setting—both explicit and implicit—which creates a new context for their dialogue and mutual relationship. There is also the analyst's conscious participation in the interaction that ensues, which is based on his or her knowledge of theory and technique, previous experience (both personal and professional), and best judgement. And there is the patient's own conscious contribution and judgement. All of this fuels the manifest dialogue and interaction, but the major part of what is happening between these two people is still unconscious, and can only be partially known as a result of an ongoing effort to examine, interpret, and understand their shared experience. This effort is originally introduced by the analyst, but it is expected that, sooner or later, it might turn into a shared endeavour to find out “what is happening to us, and what does it mean”.

 

Chapter Niine - Interpretation, Insight, and Working through

ePub

CHAPTER NINE

Interpretation, insight, and working through

To interpret or not to interpret?

Psychoanalysis was defined by Freud (1904a), as we have already seen, as “an art of interpretation” (p. 252), since it was set on the task of “making the unconscious conscious” or, as Pichon-Rivière (1971) used to say, “making explicit the implicit”. Of course, Freud's (1915d) original conception of the unconscious as identical with the repressed seemed to restrict its contents to the set of antisocial or immoral impulses and wishes, and to the most painful or unpleasant memories that had been mercifully forgotten. Any other mental contents of which the subject was not aware really belonged to the pre-conscious, and not to the dynamic unconscious (Freud, 1912g, 1915e). But with his later revision—in The Ego and the Id (Freud, 1923b)—of his theory of the structure of the mind, it became obvious that the unconscious was much wider than the repressed, and that it included not only mental contents, but also mental structures, functions, and processes. Hence, not only the id, conceived as a boiling cauldron of primitive impulses and wishes, but also large parts of the ego and the superego could now be regarded as belonging to the unconscious. So now all kinds of thoughts, beliefs, feelings, arguments, values, decisions, strategies, and assumptions could be a part of the unconscious mental processes and contents, and, consequently, become a valid object for interpretation.

 

Chapter Ten - The Evolution of the Analytic Process (1): The Beginning and the Middle

ePub

CHAPTER TEN

The evolution of the analytic process (1): the beginning and the middle

Drawing on a stream

Any attempt to describe the evolution of a fluid process invokes the temptation, which stems from the way our minds work, of dividing it into stages. This is bound to prove to be as hopeless as drawing pictures on a stream, and yet the structure of Indo-European languages demands that we artificially divide any continuous evolution in order to be able to speak about it (Whorf, 1956). This might be a useful fiction, as long as we keep in mind that these bits and pieces of an organic whole do not really exist, but are only stylistic props to aid us in the description. So, I shall try to depict the evolution of an analytic process in terms that are ample enough to accommodate the inexhaustible variety of the analytic relationship and to avoid any attempt to use them as a blueprint for the conduction of treatments.

It would seem, of course, a truism to say that the analytic process has a beginning, a development, an end, and an aftermath. If analysis were a disease, we could speak of a preclinical stage, almost unknown to us, since it happens before we first meet the patient, in which the latter is incubating the very idea of entering analysis. Then would come a clinical stage, going from the ill-defined prodromes, through a well-established status phase, to its denouement. This would be followed by period of convalescence. But the main liability of this analogy is that it seems to uphold the conception of a “natural history” of the analytic process, as suggested by Meltzer (1967), which leaves out the unpredictable and creative nature of human relations.

 

Chapter Eleven - The Evolution of the Analytic Process (2): The End

ePub

CHAPTER ELEVEN

The evolution of the analytic process (2): the end

The meaning of the end

We have already seen the inception and the beginning of the process, as well as its prolonged middle term. It is now time to approach the subject of its end. But what do we mean by “ending an analysis”? Common sense tells us that a treatment ends when the patient and the analyst no longer meet on a regular basis, but in our discipline things do not usually follow this kind of logic. Freud (1937c) clearly stated this in “Analysis terminable and interminable”, which represents his major effort at tackling this problem; there, he suggested that the end of the analysis comes when both parties no longer meet for analytic sessions, and that this happens when two conditions have been met: first, that all symptoms, inhibitions, and anxieties have disappeared, and second, that the analyst judges that “so much repressed material has been made conscious, so much that was unintelligible has been explained, and so much internal resistance conquered, that there is no need to fear a repetition of the pathological processes concerned” (p. 219). But there is still another possible meaning of terminating an analysis: that the patient has reached a level of absolute psychic normality and there is every reason to expect that this state will endure. This, he felt, happens in some favourable cases.

 

Chapter Twelve - The Healing Process

ePub

CHAPTER TWELVE

The healing process

Is there actually a cure?

The fact that psychoanalysis emerged from medicine determines that it is largely committed to the use of the medical metaphor. Thus, emotional suffering, conflicts, existential doubts, and other kinds of distress derived from life situations are called an “illness”, the attempt to aid people to overcome such a situation a “treatment”, and the wished-for outcome, which includes an alleviation of the initial malaise, a “cure”. But is it a happy metaphor? Most psychoanalysts would agree that it is only sketchy and partial at best, but that it can hardly be avoided. Bion (1970) posed this problem in clear-cut terms:

Psycho-analysis cannot escape ideas of cure, treatment, illness, in psycho-analysts and patients alike. Eissler warns against a structure that is too rigid and too limited to permit development. At the opposite extreme the Sufis have no rigid institution yet have endured; their solution would open the way for an “expanding universe” of psycho-analysis but it would not be long before members of the psycho-analytic movement could not understand each other. (p. 83)

 

Details

Print Book
E-Books
Chapters

Format name
ePub
Encrypted
No
Sku
B000000021172
Isbn
9781781812877
File size
433 KB
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Format name
ePub
Encrypted
No
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Sku
In metadata
Isbn
In metadata
File size
In metadata