Unraveling an Enigma

ABSTRACT

Confrontation is one of those terms that seem to be an inherent part of psychoanalytic technique. However, the way confrontation is used by many analysts, i.e., confronting split-off unconscious elements, seems based on Freud’s cathartic principles. I highlight how seemingly disparate theories use confrontation in this way and question its usefulness. Recent developments in the psychoanalytic method are discussed that potentially lead to different ways of bringing unconscious elements to the analysand’s awareness. Finally, the use of clarification as an alternative to confrontation is explored.

Notes

¹ I primarily refer to work with neurotic and less severe character disorders. Kernberg’s (1976) understanding of the necessity for confrontation with severe character disorders has been well documented.

² I realize there are numerous perspectives where confrontation is a basic staple, and have been presented as such. However, by far the most frequent references are descriptive… i.e., “I confronted the patient…”, with few theoretical elaborations.

³ Although Sterba’s paper appeared in English in 1934, it first appeared in German in 1927. It was the first paper to employ the insights from Freud’s (1923) move to the Structural model, and his second theory of anxiety (Freud, 1926).

⁴ I am defining confrontation as when the analyst directs an analysand’s attention to something that is unconscious.

⁵ I am referring only to work with the neurotic to mildly severe character disorders.

⁶ Sterba’s method depended on enlarging the Ego’s capacities via the analyst serving as an auxiliary ego, rather than an analysis of the resistances. It had, as its basis, a highly intellectualized approach.

⁷ For an example of working with more disturbed patients, see the section on language action.

⁸ These are elaborated in much greater detail in Busch (2013).

⁹ Here Green is talking about working with patients in the neurotic to moderately severe character disorders. In his work with patients where there is a lack of representation, for example in his paper on “the central phobic position” (2000, p. 429), there is a long period of time where other modes of working, like containment, are necessary before representations can be built.

¹⁰ For example, Baranger (1993), Ferro (2003), Ikonen (2003), Joseph (1985), and Gray (1986).

¹¹ What leads me to put these concepts together is that each author describes the thinking he is trying to describe as concrete, and focusing on “before the eye” reality. It is close to Marty’s (1962) operational thinking, where “the subject remains constantly on the level of actions; his mode of functioning adheres closely to the materiality of the facts” (p. 452). It is a different type of thinking than Stern’s (1983) concept of unformulated experience, which he described as “the label I have chosen to refer to mentation characterized by lack of clarity and differentiation” (p. 71). What I’m trying to describe is not unformulated, or unrepresented as described by Botella and Botella (2005), but rather thinking formed in a different manner.

¹² I have changed this term from the one I used previously (Busch, 1989, 1995, 2009), because many continued to think this was linked to Schafer’s (1976) action language, in spite of attempts to specify the differences.

¹³ Unfortunately, Gray’s rigid approach to analyzing resistances led many to discount his basic idea of the importance of analyzing resistances.

¹⁴ Strachey didn’t ignore resistances, but had the idea that the resistances needed to be demolished, as was typical of that time, and much later (Busch, 1992).

¹⁵ See my discussion (Busch, 2006) of a case presented by Bott-Spillius.

¹⁶ Betty Joseph and Michael Feldman, on the other hand, are generally more focused on the patient’s experience of what is occurring in the immediacy of the transference in the room, content to work with derivatives of the unconscious, and what is more knowable by the patient.

¹⁷ Although not specifically designating what is confronted as unconscious, the fact that it is split-off suggests something that most analysts would judge as unconscious.

¹⁸ I call it a countertransference as Davies seems unaware she is flirting at the time she’s engaging in it.

¹⁹ Although I have focused on Davies work as exemplifying a relational perspective, see also my discussion of a case by Aron (Busch, 2001).

²⁰ I have discussed a similar example from Brenner (Busch, 1999).

²¹ Arlow’s paper is intended as a critique of technical dictates that “have served to create a state of mind, especially in candidates, that results in a mode of response to the patient’s productions that sometimes seems frozen, wooden, in effect, undynamic. It is what I call stilted listening in terms of Webster’s definition of the word: ‘artificially formal or dignified, pompous’” (p. 221).

²² There are conceptual ambiguities in Bibring’s views, but there has been little advancement in the technique of clarification since his 1954 paper.

²³ I have gone into this in great detail previously (Busch, 2009).

²⁴ The French, the Kleinians, most of Europe and Latin America, and those still working within a Freudian tradition in America, and its developments over time.

²⁵ How the analyst remains benign while bringing up these dangerous impulses is something of a puzzle. However, maybe it helps explain why the Kleinians find so much aggression in their patients, rather than libidinal attachments.

Additional information

Notes on contributors

Fred Busch

Fred Busch, Ph.D., is a Training and Supervising Analyst, Boston Psychoanalytic Society and Institute.