Therapeutic technique in psychoanalysis and psychoanalytic psychotherapy.

As the distinctions between what we consider to be psychoanalysis and what we consider to be psychoanalytic psychotherapy have become more uncertain and more blurred, it follows that it is equally difficult to designate the techniques that would be appropriate and specific for each modality. The problem has been compounded by the fact that in recent years psychoanalysis in the United States has become considerably less homogeneous than in the past and the ego-psychological structural model is no longer the only point of view in the psychoanalytic marketplace. Further, with alterations in the criteria for analyzability, cases which, generally, had not been viewed as suitable for analysis, have been appearing with increasing frequency on psychoanalysts' couches. We have also recognized that the degree of congruence between our expectations from and the results of psychoanalytic treatment was often less than anticipated. It appears that analysts have become considerably less arbitrary about what psychoanalysis is and how a psychoanalysis can be carried out. The author is unable to delineate one technique that is intrinsic to and limited to psychoanalysis. There are, however, differences in degree and emphasis in the ways in which various techniques are applied in the therapy of psychoanalysis as compared to the therapy of psychoanalytic psychotherapy. Special attention is given to the role of a psychoanalytic process and the central place the analysis of resistance plays in psychoanalytic therapy.     

Psychoanalytic lexicography: notes from two "harmless drudges"

The co-Editors in Chief of the American Psychoanalytic Association's new edition of Psychoanalytic Terms and Concepts (previously edited by Moore and Fine and last revised in 1990) recount their lexicographical adventures. Editing a dictionary at the turn of the twenty-first century is a daunting, some might say foolhardy, undertaking. The most obvious challenge faced by the editors was the growing pluralism within psychoanalysis. However, a more fundamental challenge was that the object of psychoanalytic study, the mind and its processes, can be known only by putting words to our observations, inferences, and interpretations. Psychoanalytic thinkers, starting with Freud, have wrestled with this challenge in ways that define the history of psychoanalysis itself. Long gone are the days when Freud could commend the "correctness" of Sterba's lexicographical efforts. Today postmodern critics, at the opposite extreme, argue that terms and concepts are best understood as "verbal gestures" in the "language-game" of psychoanalysis. Some go so far as to assert that dictionary-writing is obsolete. The co-Editors in Chief of Psychoanalytic Terms and Concepts have not succumbed to such nihilistic views, but have instead struggled to establish a reasonable stance within contemporary debates over the nature of psychoanalytic language.     

Validation of psychoanalytic theories: Towards a conceptualization of references

The authors discuss criteria for the validation of psychoanalytic theories and develop a heuristic and normative model of the references needed for this. Their core question in this paper is: can psychoanalytic theories be validated exclusively from within psychoanalytic theory (internal validation), or are references to sources of knowledge other than psychoanalysis also necessary (external validation)? They discuss aspects of the classic truth criteria correspondence and coherence, both from the point of view of contemporary psychoanalysis and of contemporary philosophy of science. The authors present arguments for both external and internal validation. Internal validation has to deal with the problems of subjectivity of observations and circularity of reasoning, external validation with the problem of relevance. They recommend a critical attitude towards psychoanalytic theories, which, by carefully scrutinizing weak points and invalidating observations in the theories, reduces the risk of wishful thinking. The authors conclude by sketching a heuristic model of validation. This model combines correspondence and coherence with internal and external validation into a four‐leaf model for references for the process of validating psychoanalytic theories.     

The Perennial Freud: Method versus Myth and the Mischief of Freud Bashers

Nowadays Freud bashing is not only à la mode, in certain circles it has become de rigueur. Once a name of respect, Freud has become a name of ridicule. But like any scientific method, body of knowledge, and therapeutic procedure, psychoanalysis should be subjected to critical scrutiny. The recent crop of hostile Freud critics may have filled a vacuum left for decades by a psychoanalytic establishment which, like the Church of yesteryear, shunned all forms of criticism intramural and extramural. A central guiding idea of this essay is the distinction between the psychoanalytic method and psychoanalytic doctrines, hypotheses, and theories. This distinction has been invariably confused by both Freud's adherents and Freud's attackers. Moreover, arguments ad rem have been conflated with arguments ad hominem. A socially responsible criticism must seek to be constructive and not merely destructive. It is the latter course that was taken by the various hostile critics that came to be labeled as Freud bashers. The time has come to take a stand against the more egregious attacks on Freud and the psychoanalytic method.     

To Be Is to Betray: On the Place of Collective History and Freedom in Psychoanalysis

This paper explores an open frontier between psychoanalysis and critical theory, the relations between subjective experience and collective history. Its drive is a concern with the question of freedom: How might contemporary psychoanalysis help us think about freedom? How could it, as a practice, help us to be free? On the theoretical level, the paper follows the critique of psychoanalysis offered by Foucault and Adorno, particularly the latter's close reading Ferenczi in Negative Dialectics and his notion of “the spell.” I employ their critique in order to articulate the dilemma psychoanalysis faces vis-à-vis the notion of freedom in social context. I argue that, unlike traditional psychoanalytic discourse, relational psychoanalysis can address this dilemma in a generative way. I find this prospect in the readiness of relational psychoanalysis to realize the potential inherent in the psychoanalytic setting: the creation of a mutually constituted intersubjective space. I tell the story of a young woman for whom love seems impossible, and of a psychoanalytic expedition that finds her ability to love being held hostage. I suggest that what appears in one register as gender and sexual trouble appears in another as a dilemma of attachments and loyalties: my patient's ability to love is spellbound, trapped in a subjective-collective no man's land between her desire to be for herself and the unconscious demands of collective heritage. I argue that for psychoanalysis to be a practice of freedom, it must address the ways in which subjective experience answers to social forces and collective history. I question in this context the relations between freedom, guilt, and responsibility. Re-engaging Adorno, I agree that selfhood may always involve a guilty betrayal of others but argue against him that we must allow this guilt to be reconciled with living. I suggest, in conclusion, that theory is the bearer of collective responsibility.     

Strategic self-marginalization: the case of psychoanalysis

Marginality is an important concept in the history of science, though it is often used in a manner that presumes marginality to be a static designation. We contend that the dynamics of marginality are crucial to the history of psychoanalysis, a discipline that has moved between dominant and marginal positions. We address psychoanalytic marginality via three specific "cases": the marginalization among Freud and his followers when psychoanalysis was an emergent discipline; the marginality trope in Erich Fromm's popular psychoanalytic writing when psychoanalysis was orthodoxy in American academic psychiatry; and the rhetorical marginality of psychoanalysis in Sweden as psychoanalysis entered a decline within psychiatry. Our aim is to show that marginalization and self-marginalization serve interpersonal, social, and professional strategies.     

On the efficacy of psychoanalysis.

In this study we critically review the formal research literature pertinent to the outcomes of psychoanalysis and the factors influencing these outcomes. Our inquiry was conducted from a psychoanalytic perspective. We found the research yield consistent with the accumulated body of clinically derived psychoanalytic knowledge, e.g., patients suitable for psychoanalysis derive substantial therapeutic benefit; analyzability and therapeutic benefit are relatively separate dimensions and their extent is relatively unpredictable from the perspective of initial evaluation among seemingly suitable cases. The studies all contain clinical and methodological limitations which are no more substantial than in other forms of psychotherapy research, but they have not substantially advanced psychoanalytic knowledge. This raises challenges for the further development of formal research strategies native to psychoanalysis.     

Attachment theory and psychoanalysis Some remarks from an epistemological and from a Freudian viewpoint1

The author examines Bowlby's attachment theory and more recent versions of it from an epistemological viewpoint and subjects it to questioning on whether they are in line with central concepts of Freudian psychoanalysis. He argues that Bowlby's basic tenets regarding attachment theory, which later attachment theorists never seriously questioned, do not conform to scientifi c standards, and that psychoanalytic issues such as the dynamic unconscious, internal confl icts, interaction of drive wishes and the role of defence in establishing substitutive formations are either ignored or not treated in suffi cient depth. In the light of this, Fonagy's assertion that psychoanalytic criticism of attachment theory arose from mutual misunderstandings and ought nowadays to be seen as outdated is reversed: psychoanalytic criticism can only be regarded as outdated if either basic tenets of Freudian psychoanalysis, or attachment theory or both are misunderstood.     

'My capital secret': Literature and the psychoanalytic agon

Taking as my departure point Freud 's unequivocal claim in The Question of Lay Analysis that psychoanalytic education should include "the history of civilization, mythology, the psychology of religion, and the science of literature" ( Freud, 1926b, p . 246), I advocate for an integration of psychoanalysis with the arts, the humanities, and the social sciences in psychoanalytic training. Foundations in these fields are not only acceptable as preliminary to clinical training but will also provide the diverse intellectual climate that is urgently needed in psychoanalytic institutes whose discursive range is often quite narrow. To provide one example of the salutary effect of such disciplinary integration on clinical practice, I illustrate how the transformative power of literature provides compelling metaphors for the psychoanalytic encounter. Through an example drawn from within my own experience as literary critic and psychoanalyst, I describe the ways that the troubling tensions in Milton's Samson Agonistes functioned to illuminate, for me, an analysand 's 'capital secret'.     

The couch as icon

The couch has always been an integral part of psychoanalytic practice. It has even become a cultural icon representing psychoanalysis itself. However, minimal evidence exists in the psychoanalytic literature that using the couch is necessary or even necessarily helpful to establish a psychoanalytic process and conduct an analysis. Furthermore, it can potentially be harmful to patients such as those who have experienced early loss and trauma or who have significant ego organizational problems. Therefore, the use of the couch per se does not seem well suited as a defining criterion of psychoanalysis. To the extent that it may be clinically valuable, the use of the couch should be more carefully considered and critically examined.     

On the need of fundaments in psychoanalytic thinking

The questions concerning the foundations of psychoanalytic knowledge have been pressing from the beginning. Beside as a therapeutic practice, Freud conceived psychoanalysis as a science, maintaining that like other sciences psychoanalysis should have sound empirical and conceptual fundaments. Freud claimed that there is an inseparable bond (ein Junktim) between cure and acquiring knowledge in psychoanalysis. One of his aims in developing a metapsychology (analogously to metaphysics) was to explicate the conceptual structure of psychoanalytic knowledge. After Freud psychoanalysts have not reached a consensus in the questions concerning the foundations. What kind of foundations does psychoanalytic knowledge need? Are they to be found from the psychoanalytic practice and research on the couch, or rather from metapsychological constructions? In what way should psychoanalysis rely on external scientific research? The article addresses these questions, arguing that even though psychoanalytic work and knowledge do gain justification from various external sources, in the end psychoanalysis stands on its own foundations. It is further argued that especially under the prevailing plurality of theoretical and clinical approaches, psychoanalysis does not have – and does not need – a foundation that could not be further questioned. Thus a coherentist picture of psychoanalysis is defended.     

What is conceptual research in psychoanalysis?1

The development of psychoanalysis as a science and clinical practice has always relied heavily on various forms of conceptual research. Thus, conceptual research has clarifi ed, formulated and reformulated psychoanalytic concepts permitting to better shape the fi ndings emerging in the clinical setting. By enhancing clarity and explicitness in concept usage it has facilitated the integration of existing psychoanalytic thinking as well as the development of new ways of looking at clinical and extraclinical data. Moreover, it has offered conceptual bridges to neighbouring disciplines particularly interested in psychoanalysis, e.g. philosophy, sociology, aesthetics, history of art and literature, and more recently cognitive science/neuroscience. In the present phase of psychoanalytic pluralism, of worldwide scientifi c communication among psychoanalysts irrespective of language differences and furthermore of an intensifying dialogue with other disciplines, the relevance of conceptual research is steadily increasing. Yet, it still often seems insuffi ciently clear how conceptual research can be differentiated from clinical and empirical research in psychoanalysis. Therefore, the Subcommittee for Conceptual Research of the IPA presents some of its considerations on the similarities and the differences between various forms of clinical and extraclinical research, their specifi c aims, quality criteria and thus their specifi c chances as well as their specifi c limitations in this paper. Examples taken from six issues of the International Journal of Psychoanalysis in 2002‐3 serve as illustrations for seven different subtypes of conceptual research.     

Intersubjektivit?t und psychoanalytische Identit?t

The psychoanalytic identity is the result of identification with a psychoanalytic introject. It protects against the fears to which everyone who is attempting to illuminate the unconscious is exposed. In this paper the substantive issues of identity are discussed as a psychoanalyst who is a support for the work by providing concepts for the understanding of the unconscious. Using the example of the intersubjective wend in psychoanalysis it will be examined how these contents have changed under the influence of intersubjectivity. The notion that psychological development also occurs in psychoanalysis in unmistakable interpersonal contexts implies removing the restraints imposed by commitment to the technical rules and normative expectations. The intersubjective view of psychoanalysis therefore demands from the psychoanalyst an identity which is fundamentally different from that of the classical psychoanalyst. Processing the associated fears places the psychoanalytic identity at a more mature stage.     

The case for neuropsychoanalysis: Why a dialogue with neuroscience is necessary but not sufficient for psychoanalysis

Recent advances in the cognitive, affective and social neurosciences have enabled these fields to study aspects of the mind that are central to psychoanalysis. These developments raise a number of possibilities for psychoanalysis. Can it engage the neurosciences in a productive and mutually enriching dialogue without compromising its own integrity and unique perspective? While many analysts welcome interdisciplinary exchanges with the neurosciences, termed neuropsychoanalysis, some have voiced concerns about their potentially deleterious effects on psychoanalytic theory and practice. In this paper we outline the development and aims of neuropsychoanalysis, and consider its reception in psychoanalysis and in the neurosciences. We then discuss some of the concerns raised within psychoanalysis, with particular emphasis on the epistemological foundations of neuropsychoanalysis. While this paper does not attempt to fully address the clinical applications of neuropsychoanalysis, we offer and discuss a brief case illustration in order to demonstrate that neuroscientific research findings can be used to enrich our models of the mind in ways that, in turn, may influence how analysts work with their patients. We will conclude that neuropsychoanalysis is grounded in the history of psychoanalysis, that it is part of the psychoanalytic worldview, and that it is necessary, albeit not sufficient, for the future viability of psychoanalysis.     

How wide is the widening scope of psychoanalysis and how solid is its structural model? Some concerns and observations

The author advances the thesis that in the past 35 years there has been a relatively silent but nonetheless significant movement within the mainstream of American psychoanalysis toward a more "modest" position. This movement has been stimulated from different sources, sometimes with diverse goals and different programs. One determinant was the reaction to the post-World War II euphoria in regard to psychoanalysis and its possible therapeutic powers. Another element has been the ongoing consolidation of our knowledge and understanding of the ego-psychological, structural-model approach to analytic theory and technique, an approach which emphasizes both intrapsychic conflict and compromise formations. A consequence of this more modest position has been a greater appreciation of the limitations of psychoanalysis as well as the significance of those limitations. This more realistic appraisal of psychoanalysis may not have encouraged the widening scope of the indications for analysis, but the enhanced understanding of its limitations offers the promise of more effective psychoanalytic work in areas that have not been considered ideal for the so-called "traditional" analysis. It is suggested that more sophisticated approaches in the analysis of resistance and character, of "conflict" (in distinction to "diagnoses"), together with a more applicable understanding of the psychoanalytic process, can all contribute to a deepening, if not necessarily widening, of our psychoanalytic endeavors.     

Vicissitudes of ideas of cure in analysands and their analysts: a longitudinal interview study

This longitudinal prospective study focuses on analysands' and analysts' implicit ideas of how psychoanalysis might help analysands' psychological problems. Seven analysands and their analysts were periodically interviewed. Single ideas of cure from 75 interviews were inductively categorized. Nine distinct types of cures emerged, representing the wished-for goals of psychoanalysis, as well as the actions to achieve the wished-for changes. Each category might comprise more or less utopian ideas of wished-for cure as well as ideas of an attainable, more limited cure, or combinations of these. The utopian ideas of wished-for cures persisted throughout the psychoanalytic process for more than half the analysands and analysts. The abandonment of these ideas was related to the experienced outcome of psychoanalysis. The relation between the theories of one analysand and her analyst is explored in depth in a case study with special emphasis on the analytic process. The study suggests that the psychoanalytic process might profit from the analyst's observance of such incongruities and an openness to work through them.     

The enduring presence of Heinz Kohut: empathy and its vicissitudes

This paper expands upon and further develops the centrality of empathy in psychoanalysis as offered by Heinz Kohut. Using clinical examples, it differentiates sustained empathy as the distinctive component of psychoanalysis, and it demonstrates some of the difficulties in determining the boundaries of empathy in the practice of psychoanalysis. A further distinction is from mind reading, a purely cognitive exercise, as is intuition (Carruthers 2009). To pursue a psychoanalytic perception of empathy one must confront its limitations and go beyond the somewhat simplistic claim of its unquestioned therapeutic effect. Empathy is more than a cognitive act, and as sustained over time it can be difficult to achieve, can be misunderstood, and can at times have no therapeutic effect.     

In the Name of Psychoanalysis: Persistent Controversies and Evolution in Psychoanalysis: A Review of Impossible Training: A Relational View of Psychoanalytic Education by Emanuel Berman

In his book Impossible Training, Emanuel Berman stresses the historical roots of current standards of psychoanalytic training and demonstrates the persistence of controversies that have been present in psychoanalysis and psychoanalytic training from their inception. This perspective, of psychoanalysis and psychoanalytic education as evolving, encourages candidates and practitioners to be participants and creative voices in an evolving field rather than rote followers learning a trade. The author proposes ways that the transference of educators to the younger generation of psychoanalysts can facilitate or interfere with the training of candidates. Berman is applauded for shedding light on current controversies in psychoanalytic education by showing their roots in historical controversies. However, the author points out Berman's tendency to overvalue his side of the controversy rather than embrace controversy itself as in the best interest of the evolution and development of the field.     

Foundations of psychoanalysis reconsidered

Grünbaum's approach to psychoanalysis suffers from several difficulties. It imposes a standard of logical reductionism and methodological purity that not only violates the nature of psychoanalytic knowledge, but imposes an invalid standard of verification and scientific confirmation. It utilizes a brand of dichotomous reasoning that forces psychoanalytic propositions into artificial positions that do not reflect the actuality of analytic practice. It imposes a standard of verification that is impossible for psychoanalysis, along with all forms of psychological knowledge, to reach. It visualizes psychoanalysis as encompassing only one form of knowledge of human psychic life, forcing it into a model that eliminates other aspects of the psychoanalytic process, so that psychoanalysis is subjected to criticism only on one dimension among several--a kind of psychoanalytic straw man. The psychoanalysis that is so impaled often is difficult for the psychoanalytic practitioner to recognize. To the extent that Grünbaum's skillful and highly informed criticism of the philosophical bases of psychoanalysis encounters these difficulties, the value of his argument falls short of providing a useful basis for advancing psychoanalytic knowledge and particularly for promoting the quest for pertinent standards of validation within psychoanalysis.     

The story of an ambivalent relationship: Sigmund Freud and Eugen Bleuler

This paper examines the short-lived flirtation between psychoanalysis and academia and psychiatry in Europe and the reasons for, and consequences of, the fact that their paths diverged. It is argued that Bleuler's break with the psychoanalytic movement is a crucial and, until now, largely underestimated turning point. Bleuler's separation from the psychoanalytic movement was probably more important for the course it has since taken than those of Adler, Stekel, or even Jung. Bleuler's analysis by correspondence by Freud, and its failure, was of paramount importance for the future relationship between Freud and Bleuler, and for Bleuler's assessment of psychoanalysis.