The workable here and now and the why of there and then

Abstract

At an earlier time our work as analysts was easier. We searched for the repressed in order to make constructions that connected the past to the present symptoms. Making these connections conscious, based upon the continuing influence of the Topographic theory, was thought to be the curative factor in psychoanalysis. Freud (1912, 1914) briefly expressed the importance of working in the present but his main focus remained the importance of reconstructing the past. The importance of working in the present started to be fully articulated approximately 30-years ago, and has become a central part of most views on technique. However, it is the contention of this paper that, while there is general agreement on the necessity of working in the here and now, the understanding of what this means or why it is useful runs along parallel lines rather than leading to a central point. Further, it is my impression there is little agreement on the reasons for interpreting the there and then. The idea of a ‘workable here and now’ is introduced to capture how the here and now might best include the analysand’s readiness to synthesize what is offered, while a theory of the necessity for working in the here and now and the there and then is offered.

Key words:

• clinical theory
• interpretation
• reconstruction
• transference

Notes

1. As stated by Freud: “We must treat his illness not as an event of the past, but as a present‐day force” (Freud, 1914, p. 151). Also, his much quoted view: “For when all is said and done, it is impossible to destroy anyone in ‘absentia or in effigie’” (Freud, 1912, p. 108).

2. Compiling a representative list leaves out many important authors. The Sandlers (1994a, 1994b) have written many important articles on working in the here and now, but their exclusive focus on the transference brings them very close to Gill. I have previously written about some of the difficulties with their approach (Busch, 1997). Paul Gray represents the contemporary Ego Psychology, Betty Joseph’s perspective has had a major influence on the Modern Kleinians, while Levenson’s approach represents the interpersonal school.

3. Stone (1981) points out that others described working in the here and now prior to Gill, listing Ferenzi and Rank, Horney, and Thompson, amongst others. Stone’s (1973) own emphasis on working in the present preceded Gill’s work but is not elaborated so extensively.

4. Gill and Muslin’s position is also based on what they feel was a misreading of Freud’s precept to not interpret transference based on a belief Freud was referring to implicit erotic impulses.

5. Gill (1979) notes there are two types of resistances to the transference: “The one is an interpretation of resistance to the awareness of transference. The other is an interpretation of resistance to the resolution of transference” (p. 264). “The interpretation of resistance to awareness of the transference is intended to make the implicit transference explicit, while the interpretation of resistance to the resolution of transference is intended to make the patient realize that the already explicit transference does indeed include a determinant from the past” (p. 264).

6. Gill is not without awareness of this problem and states: “It is especially important to remember [that] one’s zeal to ferret out the transference itself [can] become an unrecognized and objectionable actual behavior on the analyst’s part, with its own repercussions on the transference (Gill, 1979, p. 285).

7. Hoffman’s thinking, most evident in his 1983 paper, clearly influenced Gill in this area. (Hoffman, 1983).

8. For a further elaboration of this point see Busch (1999, pp. 19–50).

9. However, Gray’s ego is an intrapsychic one from the Structural Model, while Joseph’s is based more on object relations.

10. Levenson does not conceptualize his methods as working in the here and now, but his method is very much in the here and now.

11. There is a similarity here with A. O. Kris’s (1982) views on free association.

12. I will elaborate on this point in the section on ‘there and then’ interpretations.

13. Here I am utilizing Paniagua’s (1991) concept of the workable surface.

14. I use the term ‘clinical moment’ to identify a period of affective and/or thematic contiguity.

15. In Green’s (1974) seminal paper on the preconscious, he decries that one hears little about the importance of preconscious functioning in psychoanalytic treatment. He emphasizes that we need to refine our concept of preconscious mental functioning so that the most effective clinical work can take place. He describes the preconscious as being in a “privileged space” (p. 420), between the unconscious and conscious, and between the ego and id, where patient and analyst can meet.

16. I have expressed extended descriptions of these concepts in various papers (Busch, 1989, 1995, 2006, 2009a), and will only briefly touch on them here with regard to the reasons for interpreting within the here and now.

17. I am using Frosch’s (1995) term, as it descriptively captures a quality of unconscious elements that has been characterized by others (e.g. Bion, Ferro, Green) in a somewhat similar fashion.

18. Others have used different terms which are conceptually similar to what I am describing (e.g. Basch, 1981; Bass, 1997; Frosch, 1995).

19. Bromberg (e.g. 2000; Chefetz and Bromberg, 2004), describing dissociated self‐states, views patients’ concrete thinking as the result of one degree or another of traumatic experience, so that affect regulation was not successful enough to allow further self‐development at the level of symbolic processing by thought and language. My own view (Busch, 1995, 2004) of the causes is that most conflicts and their resolution occur at a time when thinking is pre‐operational. We both see the lack of representational or symbolic thinking as significant in unconscious enactments.

20. I will not get into the interesting debate of whether we construct or reconstruct the past, or whether we are describing narrative or historical truth. I am more interested here with how interpretations of the past lead to significant changes in the mind as part of a psychoanalytic cure.

21. As I have discussed some of the concepts to be expressed in this section at length elsewhere (Busch, 2007, 2009), I will present them in summary form.