The analyst's reluctance to begin a new analysis

Given the decline in the average psychoanalytic practice, it is crucial to examine the variables affecting the individual analyst's practice. One such variable is the analyst's reluctance to begin a new analysis. Literature exploring its origins, possible manifestations, and effects on the analyst's thinking and practicing is reviewed. The analyst's reluctance is considered (1) as a defense against powerful affects, (2) as a co-created resistance, and (3) as a manifestation of the analyst's conflicts. Two clinical examples illustrate how this reluctance and its subsequent recognition influence the analyst's work. It is suggested that the present reality of a socioeconomic climate adverse to psychoanalysis, with fewer patients willing to engage in analysis from the outset, might be used to rationalize the analyst's reluctance to begin. It is also suggested that the analyst's reluctance to begin a new analysis is much more pervasive and influential than is presently recognized.     

The analyst's excitement in the analysis of perversion

The author believes that unconscious sexual excitement in the transference and countertransference is an especially problematic aspect of the analysis of perverse character pathology and that perverse sexual gratifi cation deserves a more prominent position in the clinical theory of analyzing perversion than that which has been assigned tacitly through analysts' routine focus on the defensive and destructive dynamics of perversion. He presents clinical material from the analysis of a perverse patient that illustrates the role of excitement in the transference perversion established in this analysis; and he asserts that gratifying perverse enactments occurring in the transference perversion can appear not only as conscious or unconscious excitement in the transference but also, at times most clearly, as the analyst's excitement. The author suggests that using a clinical theory that supports the analyst in understanding his excited responses as perverse countertransferences-i.e. evoked excitement complementary to the sexual component of a perverse transference-will assist him in locating and thinking about gratifying, perverse excitement in the transference where it is most usefully analyzed. Finally, he discusses some of the reasons why analysts might deny, suppress or otherwise avoid perverse countertransferences and in so doing contribute to sustaining perverse resistances.     

The analyst's space

The space the analyst creates in his consulting room gives expression to the most primitive elements in his personality. It does this despite, and even by means of, the professional conventions it incorporates. This phenomenon is first apparent in Freud's office where the space of the psychoanalytic situation originated. Here the room itself--filled with the antiquities he collected so passionately--met important narcissistic/symbiotic needs. In this sense it encodes a very early, unanalyzed level of relationship with his mother. It is suggested here that these phenomena, visible in Freud's office, are continuing elements of the analytic frame. Because of the character of the analyst and the structure of the relationship, the room becomes a mise-en-scène in which the narcissistic/symbiotic layers of both participants' characters are played out. Failing to recognize this may lead the analyst to treat seemingly regressive behavior as resistance and to intervene at developmental levels the patients has not achieved. Indeed, such "regressions" can only be understood as products of the situation itself. Phenomenologically, the analyst has become the corner in which he took refuge as a child; the corner to which the patient now comes for sanctuary. Because this connection is unconscious it cannot be called an alliance. Rather, it is a fortuitous interlocking that--like mother-child symbiosis--constitutes a matrix for new growth.     

The analyst's insights

The patient's fresh perceptions of himself come through mutative work shared with the analyst in the focused intimacy of their interaction. In finding transferential expectancies realized, the patient can experience these as yet different, providing he has the analyst's optimal participation. In this concurrence of crucial differences he can discount and discard the old perceptions that had shaped his psychic reality, and build out of them fresh insights. The analyst's regressive lapses in his best work are a liability inherent in the compromise formations comprising his work ego, built as it is out of the needs and motives of his own transferential past. The stagnation and tensions his regressive transferences contribute to the analytic work produce vivid actualization of the intrapsychic conflicts of both, now intertwined and mutually reinforcing. The analyst's self-analysis at such times can lead to resolving insights about himself that redress the impasse and restore the analytic work both must do.     

The analyst's words

Evidence of the analyst's inner processing and self-analysis is built into his choice and use of words. The dyadic context in which he speaks and the internal formation of his words are examined and considered for their implications for the analytic process.     

The analyst's witnessing and otherness

The analyst's active though silent witnessing of the patient's self-inquiry is presented as an essential aspect of the analytic process. Witnessing, though rooted in the analyst's empathy and holding, represents a more advanced development of those functions based on relational muturation from union to self-other differentiation. Self-definition and regard for otherness are seen as intrinsically unitary. Psychoanalytic witnessing is first illustrated and defined, then located as a derivative of negation in the unfolding of the analytic process, next considered in relation to current concerns for intersubjectivity, and finally linked to current shifts in philosophical thought.     

The quality of the analyst's attention

Compiled and edited from lectures on psychoanalytic technique given by the late Karen Horney at the American Institute for Psychoanalysis during the years 1946, 1950, 1951, and 1952. Further lectures in this series will appear in subsequent issues of the Journal.     

The analyst's trust and therapeutic action

The analyst's trust, a neglected topic in psychoanalytic discourse, participates in therapeutic action--through the analyst's emotional openness, "unobjectionable positive counter-transference" (see Fox 1998), the holding environment, and the promoting of adaptive internalizations, among other ways. When the analyst's trust--in the patient, in the analyst's self, and/or in the psychoanalytic process--fails, crucial interactions may occur, capable of destroying treatment, or alternatively, of restoring mutual regulatory functions and potentially leading to important mutative processes. Patients benefit from analysts' becoming sensitive to, having useful ways of thinking about, and working with their states of trust and distrust. The author presents clinical examples to illustrate these points.     

The analyst's attitude toward pharmacotherapy

The increased acceptance of medication in psychoanalysis has occurred with too little consideration of possible complications. The potentially adverse psychological effects and disintegrative aspects of this important technical modification require further examination. While the use of phenomenologically defined diagnostic criteria provides valuable guidance to the clinician, the decision to include pharmacotherapy in a psychoanalysis must be understood also as a transference-countertransference enactment. The analyst's attitude toward pharmacotherapy is an essential element in some defensive and gratifying enactments, resistances that can interfere with psychoanalytic processes. Clinical material is presented illustrating narcissistic and perverse resistances that might be facilitated by analysts' attitudes toward pharmacotherapy, attitudes often tacitly communicated in decisions to use combined treatment.     

The relevance of the analyst's character and attitudes to his work.

This paper is intended to sensitize analysts to the role of their character in analytic technique. The relation of character to countertransference, its role in analytic style, in the introduction of parameters, and in transference neurosis, will be elaborated. The problem of matching and of accounting for our failures will illustrate the complex meshing of character with more traditional factors.