Becoming an Individual: Technically Subversive Thoughts on the Role of the Analyst's Influence

Abstract

One of the most controversial issues in discussions of how psychoanalytic treatment “works” has been understanding the place and proper influence of the analyst's unique individuality on the process, and, in the terms framed in this paper, on the actual shaping of the patient's mind. This paper suggests that one reason this problem has endured is the absence of a framework for understanding how the analyst, as a unique individual with an inextricable personal mind, is key to the repair of the patient's impaired sense of agency and, as a consequence, the actual reconfiguration of the patient's mind. The paper argues that this personal process is not an unfortunate inevitability, but, like the developmental impact of the unique individuality of parents, represents an essential element, perhaps the core, of what enables real change and growth.

Notes

Thanks to Joan Goldberg, Ph.D., Ricky Pelach-Galil, Ph.D., Claudia Pimentel, Ph.D., Andrea Spirn, Ph.D., Orly Toren-Gabai, M.A., AnneWaters, Psy.D., and KristinWildt, M.A., for their careful reading and comments. Discussion by Alisa R. Levine, Psy.D., of an earlier draft was instrumental in clarifying some of the ideas presented here. Jill Gentile, Ph.D., Mia Medina, Psy.D., Linda Pollock, Psy.D., and Miki Rahmani, M.A., were especially generous in commenting on several drafts of this paper. A very preliminary version of some of the ideas in this paper will be published in Borgogno (in press).

¹Along with others (Hoffman, 1983; Mitchell, 1997; Renik, 1993), I have written elsewhere (J. Slavin, 1994, 2007a, 2007b) about some of the problematic aspects of these efforts to restrict the analyst's personal influence and his or her impact on the patient's personality.

²Whether Freud's thinking on this matterwas related explicitly or implicitly to philosophical trends stemming from the Enlightenment about the nature of man—an idealization of a kind of tabula rasa, the emergence of the individual unsullied by the influences of the world—is beyond the scope of this discussion. However, it can be suggested that approaches in psychoanalysis that privilege the idea of an uninfluenced “true” or “real” self hark back to this conception.

³As is suggested in the previous quote, in his paper Constructions in Analysis, Freud (1937b) makes one of his most forthright statements of the necessary influence of the patient's mind on the process, including, as he says, “allowing his patients to have their say.” This fundamentally relational aspect of Freud's thinking about how analysis proceeds, the power he accords the patient's mind, is often overlooked in discussions of his understanding of the treatment process. A similar sensibility is also inherent in his understanding of the patient's associative process and its influence on the analyst's mind (Freud, 1912).

⁴I have discussed elsewhere (Slavin, 1994) that this interpretation may in fact be a misunderstanding of Freud's point. A close reading of the “surgeon analogy” text indicates that Freud was more preponderantly addressing the question of the analyst's ambition and narcissism in effecting a cure. “Therapeutic ambition,” Freud says, “is the feeling that is most dangerous to a psychoanalyst” (p. 115), and he advocates that analysts should, in coping with their therapeutic zeal, model themselves after surgeons who carry out their craft as best they can and leave the outcome to God (“Je le pansai, Dieu le guerit.”).

⁵Thanks to Stephen Seligman (personal communication, November 27, 2009) for suggesting a closer look at the way Winnicott did and did not take account of the mother's subjectivity

⁶The question of the “interactive” implications of the views developed here are addressed later.

⁷ Luz-Alterman (2004) provided some especially striking examples and a compelling relational formulation of the powerful impact of patients on the mind of the analyst

⁸In previous writing (J. Slavin et al., 1998) colleagues and I have discussed the question of the potential danger of the analyst's real person and real influence on the analytic process and on the patient and how concerns about this have affected our theory and our practice for generations. In that earlier work, and now, I argue that the deleterious effects of a narrowed and constricted (unreal) analytic responsiveness may represent a greater harm—as well as an impossible task—than would be accepting, knowing and welcoming the analyst's inevitable realness and impact.

⁹It is rarely noted that the classical process of listening to patients' associations is not simply a way, derived from positivism, of observing the mind and affect of another, as if outside. It also represents an ingenious mode of attuning oneself to, and participating with some potentially greater awareness in, the ebb and flow of thought and affect engendered by the minds of two people.

¹⁰Similar views were expressed in the next generation of venerated classical contributors. Elizabeth Zetzel (1958/ 1970) noted that “otherwise warm and friendly psychiatrists often adopt in the analytic situation an attitude of silence and uncompromising rigidity. … It may be the analyst's conviction that any real relationship between patient and himself should be rigorously avoided.…It is, however, my increasing conviction…that serious problems in subsequent transference analysis may frequently be attributed to failure to achieve a secure therapeutic alliance” (pp. 204–205).