The psychoanalytic process

Analysts differ in how they conceptualize the psychoanalytic process, according to their understanding of the psychoanalytic theory of mental functioning in general and the nature of pathogenesis in particular. Emphasizing that psychoanalysis is a psychology of mental conflict, the authors see the psychoanalytic process in terms of the dynamic interplay between the manifestations of the patient's unconscious and the analyst's interventions. What analysts communicate to analysands serves to destabilize the equilibrium of forces within the mind, leading to the analysands' growing understanding of the nature of their conflicts and how they deal with them. Psychoanalytic process, accordingly, cannot be distinguished or separated from psychoanalytic technique.     

Conceptualizations of the psychoanalytic process

A demonstrable psychoanalytic process involves elaborate and sustained intrapsychic experiences and phenomena for both analysand and analyst. It also includes a complex and at times subtle interpersonal relationship in which each participant is actively sensitive and responsive to verbal and nonverbal input from the other. These interpersonal experiences stimulate further intrapsychic responses which in turn may have further interpersonal effects. Within the framework of the psychoanalytic situation, these combined intrapsychic and interpersonal responses lead first to facilitative and ultimately to definitive changes in the patient's psychological organization and function. A method for demonstrating a psychoanalytic process is described.     

Illness in the doctor: implications for the psychoanalytic process

The meaning and impact of serious illness in the therapist is described as it affects the doctor's intrapsychic analytic space, the analyzing field, and the fantasy life of patients. The brief literature on this topic is reviewed with particular reference to what patients should be told about one's illness. The author's experience of serious illness is described as it related to his reaction to his work with patients. Patient material is presented that demonstrates the utility of an abstinent stance even when encountering real and disturbing events. Freud's experience with long-term disability is recalled and the special circumstances posed by major illness for the analytic relationship are discussed. The unparalleled experience provided the patient by one's delicate neutrality at such times reveals to him the true depth of unconscious fantasy and its lasting influence on adult functioning.     

The psychoanalytic process: the developmental and the integrative

Psychoanalysis is a treatment that focuses on intrapsychic events and activates integrative tendencies to promote-insights. Almost from the time it originated, however, it was also promoted as a therapy informed by the interpersonal, inducing change through experiences generated within the psychoanalytic situation. In recent years the interpersonal or object relations approach has come to be categorized as "developmental," a term that fosters no end of ambiguities. The resulting confusion compromises the study of the actual developmental process on the one hand and the structure-enhancing features of transactions on the other. This encumbers research on the psychoanalytic process. The author distinguishes the intrapsychic from the interpersonal, the integrative from the developmental, and the two very different realms of psychological activities currently advanced as "developmental."     

Defense and resistance in the psychoanalytic process

"Defense" and "resistance" are usually regarded as two separate and distinct concepts, the first belonging to psychic functioning in general and the second to therapy, yet this distinction is far from constant. Clinical observations indicate a frequent overlapping of these two mental functions or positions. A patient's behavior may convey the meaning of either or both concepts, and a position or response that one assumes to bespeak resistance may reveal defense instead. This state of affairs may be seen in the analysis of patients with a relatively well-integrated neurotic identity, but its main import is in the analysis of psychosomatic patients and those with severe personality disorders. Insufficient holding experiences during the infancy of these patients do not enable them to develop functional structuralization. Deficient mothering in the first stages of life also prevents the stable differentiation between defense against threats from within and resistance against influence from outside.     

Psychic reality in the psychoanalytic process.

The case is made for regarding psychic reality as synonymous with subjective (conscious) experience, which is inherently open to, but not reducible to, unconscious determinants. Both analyst and analysand engage in the analytic relation and interaction from the perspective of their respective psychic realities. Thus, components of the analytic relation--transference/countertransference, alliance, and real relation--are forms of psychic reality. The tensions of subjectivity and objectivity are discussed in relation to the analytic situation, especially with regard to whether the patient's or the analyst's psychic reality is to be given priority or preference. The same reality, situation, or relationship can be viewed from different perspectives and subjected to varying interpretations without any one being exclusively true or false-each may be partially true and/or partially false. The patient's recounting of his history is a part of the patient's psychic reality that intersects with a necessarily divergent account constructed by the analyst. The ensuing dialogue seeks a form of real coherence that is mutually realistic and makes realistic sense for both parties. Reliance on subjective psychic reality becomes a possible, but precarious and potentially misleading, basis for analytic understanding without other observational (verbal and behavioral) or objective data.     

Beauty treatment: the aesthetics of the psychoanalytic process

Psychoanalysts enjoy doing analysis above and beyond its usefulness to patients; one reason for this lies in the aesthetic pleasure the analyst may derive from the analytic process. The author discusses this aesthetic pleasure from the standpoint of meaning making, communication, love, and professional craft. Patients may themselves seek in analysis a certain kind of beauty that is normally a byproduct of good enough empathy and communication. Using Kleinian theory, the author examines the ways in which destructiveness and aggression may be understood in relationship to an aesthetic of psychoanalysis. It is further proposed that the aesthetic and ethical principles of psychoanalysis are indissolubly linked.     

Repression and splitting in the psychoanalytic process

The authors examine the concepts of repression and splitting and their interplay during the psychoanalytic process. Initially, repression was introduced by the clinical phenomenon of resistance, leading to the formulation of the association between intrapsychic conflicts and neurotic symptoms. Later, repression was linked to normal development and to personality organization. Splitting, on the other hand, has been defined in quite diverse ways. The two main definitions are of splitting within the ego, and splitting of representations of the self, and of internal and external objects. Repression and splitting are compared developmentally, dynamically, and with respect to their relationship to psychic functioning and energic conditions. Clinical material is presented from the analysis of a patient who presented with borderline personality organization and narcissistic features. During the initial phase of analysis, splitting associated with projection, projective identification and idealization were the main defence mechanisms. As the analysis progressed and the themes of omnipotence and mourning were explored with the simultaneous working through of drive derivatives expressed in the transference, repression gained ground over the more primitive defence mechanisms. The evolution of the case showed a gradual shift from splitting to repression and the association of repression with a more advanced psychic organization. This development reflected the dynamic movement from borderline to hysterical organization in psychoanalytic nosology.     

Future and potentiality in the psychoanalytic process

A perspective is delineated on the dimension of the future in the psychoanalytic situation. Clinical manifestations are presented of the tension between actuality and potentiality that characterizes the treatment situation. This tension, an aspect of the intersubjective field that exists between patient and analyst, involves the analyst's hopes, expectations, anticipations, sense of purpose, and therapeutic intent, facets of the analyst's subjectivity that affect the clinical process. The question of the patient's individuality and autonomy is raised in the context of the notion of the "true self." To understand potentiality in the clinical situation, it is argued, the intersubjective emphasis on the inevitable mutual influence between analyst and patient must be complemented by a view of the self as emerging from within and gaining coherence through the unfolding of inherent dispositions and potentialities.     

Group supervision and the psychoanalytic process

This article attempts to elucidate the psychodynamics of group supervision of group psychotherapists. The significance of the supervisory setting is explored with a particular emphasis on the frame. The regressive interactions in group supervision are regarded as enactments, which are conceptualized as nonverbal communications that are covertly transmitted. Enactments offer a link between the present group (supervisory group) and the absent group (the therapy group that is being supervised). The relationships between the experiential and didactic components of group supervision are also addressed. Clinical vignettes illustrate the interplay between the present and the absent group focusing on the supervisor's interventions.     

Rebirth fantasy and the psychoanalytic process

In this paper, Jungian and Freudian perspectives on the fantasy of rebirth are explored and a brief review of the literature on the theme is used to show how that the rebirth fantasy seems to be a universal fantasy in the human mind, connected with the experience of both destruction and creation. In the psychoanalytic process the rebirth fantasy is connected with initial hopes for a better life, but is also a vehicle for creating the analytic pair and for separating from the 'totalitarian object'. An account of clinical work with a patient is given to illustrate the mutual and parallel process of rebirth in both the patient and the therapist. For the patient, the therapy was experienced as an awakening or a birth. The therapist was initially doubtful about the patient's capacity to engage in the analytic process but his involvement and interest were 'born' during the early sessions, enabling the patient to rely on him to lead her out of the claustrophobic power of the totalitarian object.     

Further observations on the psychoanalytic process

The psychoanalytic process remains a fascinating and valuable concept, albeit an incompletely understood and controversial one. The author reviews the ideas in his 1984 essay and looks back on some of the critiques and proposals that followed that paper. He suggests that the concept of the psychoanalytic process is viable and useful despite its shortcomings. Consideration is given to the goals of psychoanalytic treatment as they relate to the "process" and how the "process" may be helpful in determining whether or not a patient is "in" analysis.     

Some observations on the psychoanalytic process

The author's aim is to delineate the psychoanalytic process and to distinguish it from the psychoanalytic situation, the transference neurosis, "insight," and psychoanalytic technique in general. Freud's 1913 views provide the basis for a concept of the psychoanalytic process centered on the recognition and interpretation of resistances and on the patient's reactions to the analyst's interventions. This clinically observable "unit" of the process is described and compared with Bernfeld's "facts of observation." The proposition is advanced that the process does not come to an end with the termination of analysis. It continues postanalytically in the form of the patient's more objective and more effective capacity for self-observation. The paper closes with a warning about the "pitfalls of perfectibilism" and with a plea for the elevation of the not-so-good analytic hour.     

The creative process in psychoanalytic treatment

Conclusion In summary, then, what is conducive to creative functioning is arelaxation of one's rationality: the analyst who feels exhilarated rather than threatened, receptive rather than anxious, at the hint of an appearance of the unexpected, at the peeking out of something that may challenge his understanding, that may not fit the theory neatly—he is the one who is capable of more creativity. The analyst might thus orient himself to give rein to his own inner processes, his inner radar rather than his intellect, and thus without preconceived theoretical expectations aspire to discover anew that which is uncovered ineach patient. It is this which makes each analysis a fresh experience, not a stale rehash, for the therapist; it is this which makes the analysis an authentic encounter for the patient—thus, an adventuring together.Another factor grows out of the above. If the analyst orients himself to think-feel-respondvia that deeper more personal channel of images — closer to the language of dream images early in the history of analysis recognized as the royal road to the unconscious—then he may find his creative responsiveness more liberated, his intuition in general more active for the work of the session. He thereby may enliven his reactivity not only along the pithy, affect-enriched modality of images, but also along other dimensions of intervention involving more nuanced responses of all sorts.Read at the convention of the Metropolitan Academy of Psychoanalytic Training, March 12, 1971, New York City, panel on The Creative Process.