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Abstract
This paper applies a contemporary, ‘two‐track’– transformational as well as archaeological – perspective on psychoanalytic process to clinical issues in the creation of analytic patients: case finding, recommending analysis, and recommending and negotiating the intensification of frequency of sessions in analytic psychotherapy. Central importance is assigned to the role of the mind and analytic identity of the analyst, including the analyst’s capacity to maintain an internal analytic frame and analyzing attitude from the very first contact with the patient and throughout the treatment, the analyst’s confidence in and conviction about the usefulness of analysis for a given analytic dyad and the role of the analyst’s theory, which must be broad and consistent enough to allow the analyst to feel that he or she is operating analytically when addressing non‐neurotic (unrepresented and weakly represented mental states) as well as neurotic structures.
1. Earlier versions of this paper were presented at the European Psychoanalytic Federation’s (EPF) Plenary Session of the Working Party on Initiating Psychoanalysis, held in March 2006 in Barcelona and at the 2004 winter meetings of the American Psychoanalytic Association.
1. Earlier versions of this paper were presented at the European Psychoanalytic Federation’s (EPF) Plenary Session of the Working Party on Initiating Psychoanalysis, held in March 2006 in Barcelona and at the 2004 winter meetings of the American Psychoanalytic Association.
Notes
1. Earlier versions of this paper were presented at the European Psychoanalytic Federation’s (EPF) Plenary Session of the Working Party on Initiating Psychoanalysis, held in March 2006 in Barcelona and at the 2004 winter meetings of the American Psychoanalytic Association.
2. That the minds of even neurotic patients contain unrepresented mental states and therefore have non‐neurotic sectors is implicit in CitationFreud’s (1923) description of the id as force rather than specific content and was noted explicitly in Analysis terminable and interminable: “Every normal person, in fact, is only normal on the average. His ego approximates to that of the psychotic in some part or other and to a greater or lesser extent” (CitationFreud, 1937a, p. 235).
3. For example, it may be questioned how much the therapeutic gains, which Relational analysts claim to derive from ‘throwing away the book’ (CitationGreenberg, 2001; CitationHoffman, 1994), follow from the need to escape the strictures of an archaeological theory of technique in clinical situations where some other theory of technique is needed instead. Whether this ‘other theory’ is best formulated in terms of a transformational model of analysis allied to aspects of Freud’s metapsychology requires a more comprehensive and extended discussion than the scope of this paper permits. The two‐track model that I am proposing may be only one of several possible solutions to the problems that I believe arise from a predominant or exclusive reliance upon the archaeological model. For those who already operate from within such a model, albeit a different one, I hope that what follows will offer confirmation. For those who lack such a model and are struggling to maintain a consistent sense of operating within an analytic framework when faced with non‐neurotic patients and situations, I hope that what follows will prove useful.
4. This definitional shift from extrinsic to intrinsic factors is consistent with the aims of CitationGill (1994), who urged analysts to link their definition of psychoanalysis to therapeutic process rather than frequency of sessions and use of the couch.
5. For a discussion of the analyst’s affirmative conviction about the success of a prospective analysis, its roots and its effects on the recommendation process, see CitationGrusky (1999).
6. Rothstein’s reversal of the once traditional position about analyzability has proven especially valuable in empowering candidates, who, because of their inexperience and uncertainty, are often in need of support and encouragement to help them recommend that their patients enter analysis. It is also useful in implicitly supporting the hopes and courage of prospective patients, who are initially faced with the difficult decision of whether or not to begin an analysis. On the other hand, the categorical way in which Rothstein has asserted that a trial of analysis should be offered to almost all patients seeking treatment has led to questions and concerns about patient compliance, the transference of authority and the potential for authoritarian, even unethical, misuse of his recommendations (see CitationBornstein et al., 2000).
7. This case was taken from CitationReith and Crick (2007)Looking again at the dynamics of preliminary interviews, the report on work in progress of the Working Party on Initiating Psychoanalysis (WPIP) of the European Psychoanalytic Federation.
8. It is worth pointing out that the complexity of psychic interaction is such that conceptualizing the analyst’s response as part of an enactment, with the possible negative implications that this might hold, would not negate its simultaneously functioning in a potentially positive sense, when seen from a different perspective.
9. The same may be true for the patient’s initial acceptance of the recommendation for analysis, which may have to be explored and analyzed, as well.
10. The latter is not simply a matter of adopting a voluntarily positive stance, but includes a commitment to exploring, within ourselves and with friendly colleagues, the inevitable doubts, hesitancies and resistances – even at times the sheer hatred!– toward the analytic endeavor that may arise (Scarfone, personal communication).