Our vital profession

Click to increase image sizeClick to decrease image size

* As per the agreement between the IJP, the IPA and Wiley, copyright for this article is retained by the contributors. This article forms part of a collection from the keynote speakers at the 49th IPA Congress in Boston, USA: “Changing World: The shape and use of psychoanalytic tools today”, scheduled for 22‐25 July 2015. Registration is available via the IPA website: www.ipa.org.uk/congress.

Notes

* As per the agreement between the IJP, the IPA and Wiley, copyright for this article is retained by the contributors. This article forms part of a collection from the keynote speakers at the 49th IPA Congress in Boston, USA: “Changing World: The shape and use of psychoanalytic tools today”, scheduled for 22‐25 July 2015. Registration is available via the IPA website: www.ipa.org.uk/congress.

1. In an article in a popular American magazine Pickert (2014) writes that in response to the attention‐devouring web‐based communication system we live in, where we are always connected to people and places in ways that dominate our minds, there has arisen an industry focused on the Buddhist practice of ‘mindfulness’, which some analysts have likened to free association, and evenly suspended attention, suggesting that mindfulness encourages a greater capacity to be in touch with one's mind. Thus, one can see the underlying urge people are feeling to get back in touch with their own mind. In life mirroring the theater of the absurd, Pickert took a mindfulness class because like so many, she was hyper‐connected with an iPhone, a BlackBerry for work, along with a desktop computer at the office, and a laptop and iPad at home. Without irony she later reported there are hundreds of mindfulness apps available from iTunes.

2. This follows in the tradition of the work of Wallerstein (1988) and Kernberg (1993), which was based “on the increasing attention given to the actual principles of technique that flow from alternative psychoanalytic theories, in contrast to ‘clinical theories’ derived from these various formulations” (Kernberg, 1993, p. 659, italics added).

3. It is interesting that often, when one of us discovers a new perspective on psychoanalysis, it is presented as a replacement theory rather than an addition to be integrated with what is already known.

4. I am referring to those models in the international community that use Freud's view of understanding the unconscious interior of the analysand's mind as the basis for treatment, although not the only factor.

5. In this same journal Sterba (1934) presented a view of reaching the unconscious via analyzing resistances, more in line with Freud's second theory of anxiety, where dangerous thoughts or feelings threatening to become conscious set off anxiety in the unconscious ego. It is a method that is based on analyzing the unconscious anxiety as a part of bringing the unconscious into awareness.

6. Green was one of the earliest proponents of the importance of the preconscious in our interpretive work. This perspective was captured succinctly in his statement, “There is no point in the analyst running like a hare if the patient moves like a tortoise” (1974, p. 421). As I've noted previously (Busch, 2013b), similar statements can be found in the diverse work of Paul Gray, Betty Joseph, Nino Ferro, and the Barangers.

7. Freud remained ambivalent in clinically moving from the Topographic Model, and his first theory of anxiety, to the Structural Model and his second theory of anxiety (Busch, 1992, 1993; Gray, 1994; Paniagua, 2001, 2008).

8. It could also be the beginning of a psychotic break.

9. From another perspective it is, of course, important to understand how an intervention works in a patient's mind (Faimberg, 1996).

10. In my use of Ferro's (2002) concept, if a thought or feeling is highly saturated with meaning it has a highly cathected, specific meaning. In contrast, a thought or feeling that is less saturated refers to it being not so limited by a specific meaning, allowing for greater freedom to play with it.

11. However, as I've noted elsewhere (Busch, 1992, 1993), Freud struggled with holding to this principle throughout his writings.

12. As I understand it, Marty (Aisenstein and Smadja, 2010) uncovered a very similar way of thinking in psychosomatic patients, which changed the way these patients were treated. However, we've learned since then that this type of thinking is characteristic of most patients in areas of conflict.

13. I am using thinking as shorthand for thinking and feeling.

14. This way of thinking has been described as ‘pre‐symbolic’ (Basch, 1981), ‘pre‐conceptual’ (Frosch, 1995), ‘concrete’ (Bass, 1997; Busch, 1995, 2009; Frosch, 2012) and ‘preoperational’ (Busch, 1995, 2009).

15. This may be especially true at those times Grinberg called “projective counter‐identification” (1962, p. 346).

16. Schwaber's perspective is one that is always important to keep in mind. ‘We must employ our view, or experience – even vigorously so – as an avenue to finding the patient's – as long as we recognize ours for what it is – how it seems from within our vantage point – and listen with this realization” (1998, p. 659).

17. Rizzuto (2002) has used the term speech acts that describe a similar phenomenon.

18. For an explanation of why this occurs see Busch (2009).

19. In this paper I've only engaged with those theories in the Freudian tradition, where the emphasis is primarily on the transformation of what is unconscious into representable form. Although other theories like self‐psychology and relational psychology have added a great deal to our understanding of the analytic situation, placing themselves as separate paradigms has made it harder to include them in this discussion. I believe with Rangell (2004) that the paths of reform sometimes “eschew adjustment and turn instead to an opposite extreme, with a disregarding of gains won in the past, and a depreciation of many of the original assumptions and goals of psychoanalysis” (p. 6).