Inside and outside the window: Some fundamental elements in the theory of psychoanalytic technique

Abstract

The underlying concern of this paper is that psychoanalysis as practised today is in danger of losing its specificity and so losing its way. The author suggests this is possible for three reasons: the problem analysts face in responding to the strong emotional demands the great majority of patients necessarily place on them, the unintended consequences of the apparent success of ‘here and now technique’ and the absence of good clinical theory. The paper mainly discusses the author’s ideas about some core elements of the clinical theory that all psychoanalysts must use when they are working and proposes (at the risk of being facile) some relatively simple heuristics related to them which are meant to be helpful. Recalling Kurt Lewin’s maxim that ‘there is nothing so practical as a good theory’, he will suggest that continuous reflection on how one is using theory in daily practice is highly practical, if the theory is good enough. Theory in fact is a necessary ‘third’ in psychoanalytic practice which, if kept in sufficient working order close enough to clinical experience, provides an ongoing and very necessary check on our sense of reality. But, of course, as a third it can, like reality itself, be the focus of both love and hate with equally problematic consequences. The paper starts with a clinical example of a difficult but apparently successful analysis reaching its end, which will be used throughout the paper to illustrate and elaborate the theoretical ideas set out.

Key words:

• countertransference
• enactment
• interpretation
• psychoanalytic psychotherapy
• technique
• theory of technique
• transference
• resistance

Acknowledgements

This paper has benefited from discussion in psychoanalytic societies in London, Warsaw, San Francisco and Sofia as well as at the University College London Conference held in honour of Ruth Riesenberg‐Malcolm’s 80th birthday on 12 December 2009. I am also grateful for the comments of two readers and the editors and to Nicola Harding for preparing the first draft of the manuscript. I am indebted to all my colleagues in the EPF CCM working party and also to the Institute students and Society members who took part in workshops where some of these ideas were explored. I should particularly like to acknowledge my gratitude to Ruth Riesenberg‐Malcolm and her thinking. She is the person who has taught me most of what I know about psychoanalysis; not didactically but through experience.

Notes

1. This idea is a development by colleagues such as Racker (1968), M. and W. Baranger (2008), de Alvarez de Toledo (1996), Sandler (1976), Joseph (1989).

2. I am grateful to Arnold Wilson for this suggested formulation of “what’s wrong”.

3. Five times a week lying on the couch.

4. I am very grateful to Kirsten Falck for drawing it properly for me.

5. This is, I think, what Betty Joseph following Klein calls the ‘total situation’.

6. The third chapter of Anna Freud’s book The Ego and the Mechanisms of Defence begins with a recapitulation of the view that it is the analyst’s work to “bring into consciousness that which is unconscious, no matter to which psychic institution it belongs”. And, as she puts it: “& when he sets about the work of enlightenment he takes his stand at a point equidistant from the id, the ego and the superego” (Freud, 1937, p. 30).

7. The endeavour does raise anxiety. In fact I have repeatedly witnessed the outbreak of near‐catastrophic anxieties whenever proposals are made that the rules underlying clinical practice should be clear, formal and categorical or that we need ways securely to determine whether a particular practice is adequate or not. It seems clarity in this area stirs deep resistances even before hesitant efforts such as these are made to achieve the aims.

8. It seems to be the case that, whatever the Freudian theory about sexual, aggressive and omnipotent conflicts, psychoanalysts are taught in ‘school’– in their institutes – very often their view of what is wrong with their patients is about ‘bad’ mothers and fathers often linked to a theory of how psychoanalysis works linked to the provision of a new better chance. It is possible such views reflect the resolution of what I would call super‐ego conflicts in their own analysis about what is/was wrong with them and how it was resolved. This might explain the enormously ambivalent idealisation of training analysts and subsequent identification. I recall one psychoanalyst who consulted me some years ago because he was unhappy in his career. I asked him what he had learned about himself when he was a patient. His answer was along the lines he was bad – envious, greedy, attacking the analyst’s work and so on. My impression is that his (unconscious) belief was that the outcome was a really a kind of submission in exchange for qualification. I found it unlikely his theory was also his analyst’s theory of ‘what was wrong’ and I ended up suggesting he go back and ask. Other colleagues sometimes give the impression that analysis was ideal.

9. Theories of what is wrong that ‘blame’ someone else or take a patient’s sides versus the environment make analytic neutrality difficult and also tend to create difficulties for the perception and interpretation of negative transference. If an analyst must be good then a patient is driven to more and more extremes to work through what it is like with someone bad which can turn into a vicious circle. Here again there is a link between the theory an analyst holds about what is wrong, how repetition is brought about, where associations are ‘made’, and the theory of change. If what is wrong was a deficit in the early environment, a technique based on providing the missing ‘good experience’ tends to involve movements from neutrality to provide ‘good experience’. One could say the patient is force‐fed. They may comply. But a theory of repetition which does not include the analyst’s contribution and a notion of free association which prevents critical and aggressive thoughts against the analyst inside will make it difficult to deal with the problem of hatred except intellectually.

10. Saturated interpretations have (in theory) unambiguous meanings and so may close options for further elaborative association – which may be useful or not in a given situation.

11. Also Brenman (1985) in discussing the patient’s predicament in effect provides a Kleinian theory of resistance based on looking at it from a neutral but empathic countertransference position.

12. The issue relates to the disenchantment in some quarters with ‘interpretation’ and the emphasis on providing a good enough relationship. It is broadly represented by the arguments made by Alexander (1935) with his notion of the ‘corrective emotional experience’.

13. ‘What’s wrong’ theories of psychic change were also not well developed and very often implicit. When explicit they were often rather sketchy and could often be contradictory. A large number focused on the notion of providing a new object or new experience but far fewer in how that was done. Others focused on the issue of whether it was the analyst or the patient that really did the work. Others on what was called containing which was often related to theories about what the analyst supposed it would not be possible to talk to the patient about, which often concerned what is known as negative transference.

14. This is a point often made in discussion by Ron Britton.