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.     

Therapeutic insight and tolerance of ambiguity

The author discusses the implications of the psychoanalytic concept of insight. He refers to it as an "action-steering utopia of the psychoanalytic process".     

The analytic surface and the theory of technique

This paper examines the concept of the analytic surface as a starting point for the interpretive process in relation to the theory of psychoanalytic technique. The history of the concept of the analytic surface within psychoanalysis is reviewed. Four different conceptualizations of analytic surfaces are described (M.M. Gill, P. Gray, A. Kris, E.A. Schwaber). The advantages of a "surface" approach are explored in relation to clinical work, the teaching of psychoanalytic technique, and opportunities for research. Some criticisms of the concept are explored.     

A core process in psychoanalytic treatment

A core mechanism of the psychoanalytic process is described. This involves the effects of treatment on an ongoing "unconscious intrapsychic process," which has specific points of vulnerability to pathology. The concept of an intrapsychic process described by the author in previous publications is an expanded formulation of the idea of thought as trial action and of the signal theory of anxiety. The psychoanalytic method alters the functioning of the ego astride this unconscious process, strengthening its control over anxiety, defense, trauma, and symptom formation. This is mutative in the psychoanalytic method.     

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.     

Meaning without words, word without meaning: forgetting of "aliquis". Remarks on Grünbaum's critique of repression

The author addresses the critique of the psychoanalytic concept of repression developed by Grunbaum in regard to Freud's interpretation of forgetting in the "aliquis episode". Reiff counters by pointing out the indispensability of a hermeneutic approach to the transference-countertransference process and supports his contention with case illustrations and with reference to the psychoanalytic discussion of symbolization.     

The infant and the infinite: On psychoanalytic faith – Bion,Meltzer and Kierkegaard

This paper discusses the meaning of psychoanalytic faith as a useful developmental concept, which applies to the therapeutic process in the consulting room as to other intimate educational experiences. Faith is a concept which has been little considered in relation to psychoanalysis, partly owing to semantic confusion with ‘the Faith’ as in religious or psychoanalytic dogma, and partly owing to the difficulty of defining or describing what it is, outside accepted jargon. Yet, faith is traditionally the gateway to experiencing the unknown – a psychoanalytic goal-demanding negative capability. It is suggested that philosophy and poetry, where the concept is more familiar, can provide psychoanalytic parallels for this particular type of learning from experience. The viewpoints of Bion, Meltzer and Kierkegaard are taken as contributing to a picture of how, in the psychoanalytic session, there may be a developmental encounter between the infant (patient) and the infinite (the transference process, rather than the analyst as a person).     

Psychoanalytic attitude as a step in the transference/countertransference relationship

When the psychoanalytic treatment process reactivates the "primary oral conflict" in the patient, the author recommends that the analyst put off transference interpretations in favor of reacting with the "analytic attitude". Only after the relationship between patient and therapist has been restabilized, can the elaboration of the early conflicts be considered. The concept of the analytic attitude is essentially a synthesis of "holding" and "containing" functions.     

Turning aggression on the self: a study of psychoanalytic process

The concept of turning aggression on the self is studied, and some clinical vignettes are presented which demonstrate the use of this concept as a guide to the formation of an "ideal" for one kind of analytic intervention with one kind of analytic surface. Pertinent literature is reviewed, and assumptions implicit to the analyst's activity are discussed. This endeavor is viewed in the larger context of attempts to arrive at a clearer understanding of the psychoanalytic process.     

The concept of termination and the evolution of psychoanalytic thought

Termination is a post-Freud contribution to the psychoanalytic process, which is never complete. The concept is illuminated in its analytic history and development. A formal well-defined terminal phase led to a tripartite psychoanalytic process which derived from and contributed to advances in psychoanalytic theory and knowledge. The terminal phase is a valuable addition and conclusion, but may be invested with irrational expectation and analytic myth. Various features and formulations of the terminal phase are explored, and the limitations of termination are noted.     

Toward a definition of psychoanalytic neutrality

The word and concept of neutrality play an important but confusing role in the history of psychoanalysis. Does neutrality imply indifference? The origin of this ambiguity is traced to the fact that Freud himself never used the word "neutrality" (Neutralitaet) in his own writings. (His term Indifferenz was translated as "neutrality" by Strachey.) The essence of the controversy that has simmered in the psychoanalytic literature ever since is contained in the question: "Is remaining true to the concept of neutrality somehow antithetical to the analyst's genuine involvement with the patient?" In this paper, I examine the feeling and power aspects of the word and suggest that the concept of neutrality becomes clinically useful when the analyst asks himself the question, "Neutral to what?" The analyst's awareness of his motives for recognizing and addressing certain conflicts and for overlooking others is heightened. With three clinical vignettes as illustrations, I explore the role of the concept of neutrality in deepening our understanding of (1) the analytic relationship; (2) The influence, on the conduct of the treatment, of the analyst's goals and theoretical persuasion regarding how the goals are to be achieved. As examples, I use the current debates over the relative value of the analyst's focusing his attention on: (a) the patient's mind in the hour rather than his life outside the hour and, (b) transference over nontransference interpretation. Finally, I emphasize the far-reaching implications of adding an explicit concept of "external reality" to A. Freud's exclusively intrapsychic definition of the "objective" analyst's position of neutrality as equidistant from id, ego, and superego. The addition of this fourth point to the analyst's "compass" widens the analytic field toward which the analyst is neutral. The concept of neutrality with respect to specifiable conflicts is thereby also broadened to include (a) interpersonal conflict within the psychoanalytic relationship and (b) conflict within the analyst. With these explicit additions, the concept of neutrality with respect to conflict becomes congruent with the current emphasis on the nonauthoritarian two-persons aspects of the psychoanalytic relationship, without detracting from the primary analytic goal of deeper understanding of intrapsychic conflict.     

The empirical foundations of psychoanalytic approaches to psychological testing

The view that psychoanalytic approaches to psychological testing lack empirical foundations is disputed by systematically examining the ways in which psychoanalytic theory expands the sources of data available to the psychological tester at each step in the assessment process. The contention is made that it is unscientific to restrict the concept of what constitutes scientific rigor to formal experimentation with statistical analysis.     

The Empirical Foundations of Psychoanalytic Approaches to Psychological Testing

The view that psychoanalytic approaches to psychological testing lack empirical foundations is disputed by systematically examining the ways in which psychoanalytic theory expands the sources of data available to the psychological tester at each step in the assessment process. The contention is made that it is unscientific to restrict the concept of what constitutes scientific rigor to formal experimentation with statistical analysis.     

Neutrality, interpretation, and therapeutic intent.

Neutrality is a central concept within the theory of psychoanalytic technique. We spell out the major controversies in which the concept has become embroiled, and provide a definition that we believe coincides with actual psychoanalytic practice. We discuss its merits and weaknesses, noting also the negative consequences of relying on older definitions. We relate neutrality to the interpretive process, indicating ways interpretation protects neutrality and is made more effective by it. We discuss the complex and controversial relation between neutrality and the analyst's therapeutic intent.     

The superordinate self in psychoanalytic theory and in the self psychologies

The concept of the self has been used in several attempts to resolve the epistemological problems of what is subjective and what is objective, what is personal and what is organismic. In addition, it has been used to mediate between the hermeneutic and natural-science approaches to psychoanalytic explanation, between the motivational and causal dimensions of our theory and experience. In the case of Kohut, the self was initially invoked to deal with clinical difficulties associated with the analysis of patients with narcissistic personality disorders more recently, it has become the central article in a "self psychology" that addresses presumed deficiencies in the traditional psychoanalytic picture of psychopathology. But the concept of the self is not suited to be a panacea for resolving theoretical or clinical difficulties. The self as person refers to an entity that is both enduring and changing; it describes continuity in the face of change and change in the face of continuity. Abend (1974) comes closest to capturing this attribute of the self in his image of the tidal beach with a configuration that changes but an essence that remains the same. Eisnitz (1980) evokes something similar in his figure-ground conception of the self-representation. The crux of the matter is that the notion of self-experience includes a variety of phenomena that cannot be contained within a single self-construct--be it normal pathologic, grandiose, or otherwise. As a result of these considerations, I have argued against the use of the self as a superordinate concept in psychoanalytic theory and have focused on the shortcomings of three self psychologies that use the self in this way. I believe that Klein, Gedo, and Kohut all offer the self as a kind of conceptual tranquilizer for the philosophical, theoretical, and clinical dualities that are inherent in psychoanalytic work. Grossman addressed himself to these dualities as far back as 1967 and elaborated on the problems with Simon (1969) in a pathbreaking paper on anthropomorphism in psychoanalysis. Grossman and Simon contended that the controversy about anthropomorphism in psychoanalytic theory pertains to the basic confusion in psychology between meaning and causality. They submitted that until this confusion was dispelled and until some superordinate concept was found that could "encompass both kinds of discourse", attempts to transform psychoanalysis into a general psychology would result in failure.(ABSTRACT TRUNCATED AT 400 WORDS)     

The centrality of the psychoanalytic setting and the changing aims of treatment. A perspective from a theory of object relations

The psychoanalytic setting, which includes the bond between analysand and analyst, is the foundation of psychoanalytic treatment. This object tie, although in the here and now, and "real", is demarcated from ordinary life and can be thought of as existing within a different level of reality. The psychoanalytic setting is subject to symbolic transformations that enable non-specific developmental conflicts to be worked through. I have described this transformation as the "dependent/containing transference," which I have compared and contrasted to the highly variegated and specific "iconic" transference (transference neurosis). This view of the psychoanalytic setting leads the analyst to pay special attention to problems of entrustment and safety and to the communicative process that regulates the closeness and distance between the two participants.     

Psychoanalytic observation

The recent focus on empathy as the essential activity in psychoanalytic data gathering has underemphasized the complexity of psychoanalytic observation and has failed to identify what truly makes it unique among modes of psychological investigation. It is a process that includes introspection and empathy. However, it also includes the analyst's observation of the patient's behavior, and particularly verbal behavior, in a way that is not necessarily empathic. The psychoanalytic use of introspection and behavioral observation together, as they are modified by the analysand's free association and the analyst's evenly hovering attention, provides a unique method of data gathering. The transient, mutually related regressions of analyst and analysand which partly constitute the analyzing instrument modify the field of observation available to both, providing better access to derivatives of the analysand's unconscious mental functioning. This more complex concept of psychoanalytic observation, as opposed to that in which empathy is predominant, has important implications for psychoanalytic training, clinical work, and theory.     

How treating psychoanalysts respond to psychotherapy research constraints.

The psychoanalytic community increasingly recognizes the importance of research on psychoanalytic treatments, yet a significant number of psychoanalysts continue to believe that research is either irrelevant to psychoanalysis or impossible to accomplish. Psychoanalysts who accept the value of research express concern that intrusions required by research protocols create significant distortions in the psychoanalytic process. The authors, all psychoanalysts, are studying the outcome of a brief (twenty-four-session) psychodynamic treatment of panic disorder. They report their experiences and struggles with the intrusions of videotaping, working with a treatment manual, and time-limited treatment. This research process required them to question old beliefs and to confront feelings of disloyalty toward their analytic training and identity, particularly with regard to keeping a "clean field" and routinely performing long-term analysis of character. The therapists' psychoanalytic knowledge, however, emerged as crucial for them in managing specific research constraints. Despite concerns about providing inadequate treatment, therapists were found to engage patients with psychoanalytic tools and focus in vibrant and productive therapies that led to significant improvements in panic symptoms and associated quality of life. The authors suggest that psychoanalysts have been overestimating the potential damage of research constraints on psychoanalytic process and outcome.