Psychoanalytic process

Differing concepts of psychoanalytic process and views of its "locale" are related to how essential the interactivity of the analyst is judged to be. Scientific scrutiny of clinical psychoanalysis requires that the interactive nature of the process be recognized. In this endeavor the concept of "process model" is helpful, as is the view of psychoanalysis as a form of treatment in which therapeutic process and therapeutic agent are distinguished.     

The return of the repressed. Psychology's problematic relations with psychoanalysis, 1909-1960.

When psychoanalysis first arrived in the United States, most psychologists ignored it. By the 1920s, however, psychoanalysis had so captured the public imagination that it threatened to eclipse experimental psychology entirely. This article analyzes the complex nature of this threat and the myriad ways that psychologists responded to it. Because psychoanalysis entailed precisely the sort of radical subjectivity that psychologists had renounced as unscientific, core assumptions about the meaning of science were at stake. Psychologists' initial response was to retreat into positivism, thereby further limiting psychology's relevance and scope. By the 1950s, a new strategy had emerged: Psychoanalytic concepts would be put to experimental test, and those that qualified as "scientific" would be retained. This reinstated psychologists as arbiters of the mental world and restored "objective" criteria as the basis for making claims. A later tactic--co-opting psychoanalytic concepts into mainstream psychology--had the ironic effect of helping make psychology a more flexible and broad-based discipline.     

Controversies and Conflicts in the Institution of "Open" Psychoanalysis: Cases from the History of the Therapeia Foundation

The institution of psychoanalysis has included controversies, dissensions and expulsions at both the theoretical-methodological and personal-organizational levels. There have also been several intra- and intergroup conflicts in the history of psychoanalysis, and in constructing and patterning the future of psychoanalytic knowledge. In the context of Finnish psychoanalysis, the Therapeia Foundation (founded in 1958) met from the start with resistance from official psychiatry and also from the IPA. For example, in the mid-1960s, D. W. Winnicott, as the President of the IPA, supported the orthodox Finnish psychoanalytic study group (later to become the Finnish Psychoanalytical Society), and pronounced that the Therapeia group was too loose and was not strictly able to use the IPA-recognized designation "psychoanalytic." The Therapeia Foundation and its Training Seminar combined classical psychoanalysis and its new versions with existentialphenomenological views, anthropological medicine, research on "social pathology" and even modern theological research. On the basis of their Swiss analytic training, three Finnish psychiatrists, Martti Siirala, Kauko Kaila and Allan Johansson, organized Therapeian training to incorporate sciences and arts, and skills involving the therapeutic "carrying" of burdens. The multifacted nature of open psychoanalysis was seen to find its proper organizational expression when the Training Seminar of the Therapeia Foundation became, in 1974, a Member of the IFPS.     

A training analysis for psychoanalytic psychotherapists

For historical reasons, psychoanalytic psychotherapy has been regarded as a second-class treatment in comparison with psychoanalysis, and standards for training in it have lagged behind those for psychoanalysis. However, psychoanalytic psychotherapy is the treatment of choice for many healthier (or higher-level) patients who cannot receive analysis for any reason, and also for a large population of more-disturbed patients who are not appropriate for psychoanalysis. Mastering techniques of psychoanalytic psychotherapy may be as difficult as mastering those of psychoanalysis, and should require comparable theoretical training, supervision, and personal treatment. This "development lag" in the training of psychoanalytic psychotherapists has taken place for several reasons: (1) Psychoanalytic ideas first emerged in America in the context of a new movement toward an electric, but dynamic psychiatry from which psychoanalysis had to establish its separate identity. (2) Psychotherapy was associated with techniques of suggestion and manipulation from which psychoanalysis wished to separate. (3) Because psychotherapy was seen as an inferior form of therapy which required little training, institutes were slow in being established, and reluctant to require a "training analysis." It is suggested that with the full training of psychoanalytic psychotherapists, this discipline may be regarded as a profession comparable to psychoanalysis. It is further suggested that the optimal treatment for the full training of the psychoanalytic psychotherapist is psychoanalysis, and that a "training psychotherapy" is not an adequate substitute, but may provide a transitional step to resolve initial resistances and to prepare the therapist for a training analysis.     

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.     

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.     

Freud's psychoanalysis: A moral cure

That psychoanalytical treatment in its classical Freudian sense is primarily a moral or ethical cure is not a very controversial claim. However, it is far from obvious how we are to understand precisely the moral character of psychoanalysis. It has frequently been proposed that this designation is valid because psychoanalysis strives neither to cure psychological symptoms pharmaceutically, nor to superficially modify the behaviour of the analysand, but to lead the analysand through an interpretive process during which he gradually gains knowledge of the unconscious motives that determine his behaviour, a process that might ideally liberate him to obtain, in relation to his inner desires, the status of a moral agent. There resides something appealing in these claims. But it is the author's belief that there is an even deeper moral dimension applying to psychoanalytical theory and praxis. Freudian psychoanalysis is a moral cure due to its way of thematizing psychological suffering as moral suffering. And this means that the moral subject – the being that can experience moral suffering – is not primarily something that the psychoanalytical treatment strives to realize, but rather the presupposition for the way in which psychoanalysis theorizes psychological problems as such.     

The analyst's countertransference to the psychoanalytic process1

There is countertransference, not just to individual patients, but to the process of psychoanalysis itself. The analytic process is a contentious topic. Disagreements about its nature can arise from taking it as a unitary concept that should have a single defi nition whereas, in fact, there are several strands to its meaning. The need for the analyst's free associative listening, as a counterpart to the patient's free associations, implies resistance to the analytic process in the analyst as well as the patient. The author gives examples of the self‐analysis that this necessitates. The most important happenings in both the analyst's and the patient's internal worlds lie at the boundary between conscious and unconscious, and the nature of an analyst's interventions depends on how fully what happens at that boundary is articulated in the analyst's consciousness. The therapeutic quality of an analyst's engagement with a patient depends on the freeing and enlivening quality, for the analyst, of the analyst's engagement with his or her countertransference to the analytic process.     

THE WILDE ANALYST

Oscar Wilde (1854–1900) took on the challenge of teaching us how to live artfully. From the dynamic successes and tragedies of his own life Oscar knew that everything worthy of existence is worthy of art, including its ugliness and suffering. Oscar observed much about human nature, especially his own, in an era when convention was not challenged, knowledge was taught and appearances were everything. For him, “The supreme vice is shallowness.” Society and psychoanalysis can still be honored and shaken by his words. The paradoxical and complex nature of Oscar's insights was as good as any coming from a thoughtful psychoanalyst. After the first two attempts to write about Oscar fell flat, it became clear that I must engage with him and try to match the unsparing commitment to explore his unconscious and interior life. In the process of creating the array of sketches of my psychoanalytic encounters with Oscar, I also found the words to describe what drew me to the field some 20 years ago—the art of psychoanalysis.     

Is there a nonverbal period of development?

That the infant lives in a nonverbal sensorimotor world is widely believed. Yet this notion is being challenged by research, in a range of fields, that depicts the young infant as actively attuned to aural speech from birth and able to process and use its sounds and meanings well before the end of the first year. Following a selective review of the research on infant speech processing between birth and age twelve months, three questions are identified that highlight the theoretical and clinical implications of this research for psychoanalytic conceptualizations of infancy, the nature of language, and clinical process. The research, it is concluded, identifies the operation of linguistic and conceptual processes in early life, processes that may intersect with the experiential and emotional processes with which psychoanalysis is already concerned. Moreover, this research raises questions about the view that the nature of infancy is essentially nonverbal.     

The analyst's knowledge and authority: a critique of the "new view" in psychoanalysis

A critical assessment is presented of positions recently taken by Mitchell and Renik, who are taken as representatives of a "new view" in psychoanalysis. One article by Mitchell and two by Renik are examined as paradigmatic of certain ways of construing the nature of mind, the analyst's knowledge and authority, and the analytic process that are unduly influenced by the postmodern turn in psychoanalysis. Although "new view" theorists have made valid criticisms of traditional psychoanalytic theory and practice, they wind up taking untenable positions. Specifically called into question are their views on the relation between language and interpretation, on the one hand, and the mental contents of the patient on the other. A disjunction is noted between their discussion of clinical material and their conceptual stance, and their idiosyncratic redefinitions of truth and objectivity are criticized. Finally, a "humble realism" is suggested as the most appropriate philosophical position for psychoanalysts to adopt.     

Developmental psychology and psychoanalysis: I. The context for a revolution in psychoanalysis

After describing the manner in which the integration of psychoanalysis and developmental psychology became a central problem for ego psychology, the author examines the conditions that make it possible for new research and theory in developmental psychology to contribute to a revolution in contemporary psychoanalytic theory. They include: (1) the emergence of a state of "crisis" in American psychoanalysis centering on questions of the nature of early development and how it can be known; (2) the explosive growth of developmental research on early childhood dealing with issues at the heart of that crisis; and (3) the presence of a new generation of psychoanalysts and psychoanalytically oriented researchers capable of bringing that research to bear on those issues.     

Down to cases: the ethical value of "non-scientificity" in dyadic psychoanalysis

The efficacy of the dyadic psychoanalytic method cannot be verified empirically, due to the impossibility of counterfactuals, controls, or double-blind experiments, although inventive psychoanalytic researchers have established validation methodologies for analyzing groups of case studies, outcomes, and even theoretical precepts. The unavailability of complete empirical validation for the most basic method of the discipline of psychoanalysis, or of its fundamental "report of findings"--the case study--means that the field's scientific rationale must be supplemented with public reasoning of another sort. Fortunately, the very conditions of uncertainty that make it impossible to falsify the findings of dyadic psychoanalysis lend it its ethical force by compelling its participants to confront the basic human dilemmas of freedom, meaning, and judgment, the ethical horizon of human affairs. One substantial value of psychoanalysis, then, is its capacity for generating "ethical knowledge" of the sort adumbrated by Aristotle's conception of practical knowledge (phronesis). Case studies written for a lay audience to highlight these basic dilemmas can demonstrate that psychoanalysis produces crucial knowledge, specific to individuals, for living a healthy and satisfying life.     

What kind of discipline is psychoanalysis?

Current controversies involving clinical, conceptual and empirical research shed light on how psychoanalysis confronts its nature and its future. Some relevant debates in which Wallerstein, Green, Hoffman, Eagle and Wolitzky, Safran, Stern, Blass and Carmeli, and Panksepp have participated are examined regarding the characteristics of their argumentation. Agreements and disagreements are explored to find ways that could have allowed the discussion to progress. Two foci are highlighted in these debates: (a) whether a clinical common ground exists in psychoanalysis and what kind of procedure could contribute to further clarification; (b) complementation of in‐clinical and extra‐clinical evidence. Both aspects are scrutinized: the possibility of complementing diverse methodologies, and the nature of the shared clinical evidence examined in clinical discussion groups such as those promoted by the IPA Clinical Observation Committee. The importance of triangulation and consilience is brought to bear regarding their contribution to the robustness of psychoanalysis. So as to strengthen a critical perspective that enhances the discipline's argumentative field, psychoanalysis should take into account arguments from different sources according to their specific merits. By doing this, psychoanalysis increases its relevance within the current interdisciplinary dialogue.     

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.     

Feminism and Family Therapy

Feminism has had a profound effect on contemporary culture and on thinking in most academic fields, including psychoanalysis. Interestingly, until very recently it had made virtually no impact on the theory and practice of family therapy. This paper proposes an explanation for this peculiar phenomenon and argues that family therapy has been considerably handicapped by its insularity from the feminist critique. Utilizing feminist scholarship in psychoanalysis, history, and sociology, the paper analyzes the structural contradictions in family life that family therapists have essentially ignored and then outlines their clinical implications. Key points in the discussion include the argument that systems theory is an inadequate explanatory matrix from which to build a theory of the family, that the archetypal "family case" of the overinvolved mother and peripheral father is best understood, not as a clinical problem, but as the product of a historical process two hundred years in the making, and that power relations between men and women in families function in terms of paradoxical, incongruous hierarchies that reflect the complex interpenetration between the structure of family relations and the world of work. This conceptual model then provides the basis for an analysis and critique of sexual politics as they emerge in the prototypical clinical situation.     

Losing a father all over again: the termination of an analysis of an adolescent boy suffering from father loss

Criteria for beginning and conducting the termination phase of psychoanalysis have provoked debate and confusion from the early days of psychoanalysis. Gabbard (2009) has recently pointed to the field's tendency to cling to idealized versions of these criteria as a way to deal with disagreements. The situation becomes more complicated for child and adolescent psychoanalysts because their patients are in the midst of a developmental process at the very time they are engaged in a psychoanalytic process. The termination phase of an adolescent male suffering from father loss is presented in depth in order to provide clinical data toward further consideration of the vexing questions surrounding termination in psychoanalysis. His termination is used to examine the relative importance of losing the analyst as a transference object as against a developmental object; the meaning of action during termination; the complicating role of trauma vis-à-vis termination; and the importance of the post-termination phase of analysis. It is suggested that his termination phase demonstrates that a "good enough" termination involves the development of a self-analyzing capacity that continues to evolve and develop after termination.     

The rooting of the mind in the body: new links between attachment theory and psychoanalytic thought

The relationship between psychoanalysis and attachment theory is complex indeed. A brief review of the psychoanalytic literature as it concerns attachment theory and research, and of the attachment literature as it pertains to psychoanalytic ideas, demonstrates an increasing interest in attachment theory within psychoanalysis. Some of the difficulties that attachment theory faces in relation to psychoanalytic ideas are traced to its links to the now dated cognitive science of the 1960s and 1970s. Today, however, a second-generation cognitive neuroscience seeks neurobiologically plausible accounts in which links with brain and body are seen as shaping mind and consciousness, which increasingly are seen as "embodied", as emerging from or serving the needs of a physical being located in a specific time, place, and social context. This idea has also been at the core of much psychoanalytic thinking, which has historically affirmed the rootedness of symbolic thought in sensory, emotional, and enacted experience with objects. Now neurobiological advances supporting the concept of embodied cognition offer an opportunity to forge powerful links between the hitherto separate domains of attachment theory and psychoanalysis. Speculations about the nature of language are presented that emphasize the origin of internal working models (and of representations in general) in early sensorimotor and emotional experiences with a caregiver. It is argued that language and symbolic thought may be phylogenetically and ontogenetically embodied, built on a foundation of gestures and actions, and are thus profoundly influenced by the experience of early physical interaction with the primary object. Finally, the clinical and research implications of these ideas are discussed.     

Interpretation, psychoanalysis, and the philosophy of mind

I suggest that a conflict between two philosophical models of the mind so far unremarked in discussions of psychoanalysis is at the heart of questions about its status as a science, the objectivity of psychoanalytic interpretations, and the nature of the unconscious. In philosophy one model is embodied in the tradition of Descartes, Hobbes, Locke, Kant, among many others, which construes thought as prior to and independent of language. According to this tradition the mind is self-contained and mental contents or "ideas" are essentially subjective phenomena. It follows that knowledge of other minds and the material world is radically problematic. In the second and more contemporary model the phenomenon of meaning is dependent on interactions between minds, and between mind and the world. Since meaning is understood to be intrinsically social, so in an important sense is mind. I develop this second philosophic model, indicating its relevance for psychoanalysis. I also point out some of the contributions of psychoanalysis to philosophy of mind.     

What is psychoanalysis?

Although we are now less inclined to argue about whose treatment is entitled to be called psychoanalysis, we will understand current debates better if we revisualize what originally made psychoanalysis different from other treatments. At its birth, psychoanalysis twisted the common-sense treatments it grew out of into very peculiar shapes. In reaction to that extreme peculiarity, a process of normalizing began almost immediately and continues to this day. This process is illustrated by tracing the rise and fall of peculiarities in four aspects: medical procedure, the analyst's vision, the analyst's role, and the sense of time.