On the question of the patient's right to tell and the ethical reality of psychoanalysis

This paper calls into question the view that it is ethically legitimate for the patient to say whatever comes to his or her mind: that is, to adhere to the fundamental rule. While there have been some variations in the application of this rule since Freud's time, it remains for many the bedrock of clinical practice, and the patient's right to free-associate has never been questioned. Recent debates on the importance of the analyst's strict confidentiality have highlighted this right. Ethical problems raised by adherence to the fundamental rule are explored through an examination of the general ethical limitations on what one may say to another person, and the special features of the analytic relationship that seem to do away with these limitations. The fact that there are ethical questions about adherence to the fundamental rule draws attention to what the author calls the ethical reality of psychoanalysis. The recognition of this reality has implications for the understanding and handling of ethical dilemmas regarding disclosure, as well as for other ethical issues that may arise in the course of an analysis.     

Slow magic: psychoanalysis and "the disenchantment of the world"

Freud's work can be situated in terms of the debate between Enlightenment and anti-Enlightenment thought. The attempts of both sides to claim Freud for their position have merit, but they miss the crucial point: namely, that the tension between its Enlightenment and anti-Enlightenment tendencies is what gives Freud's thinking much of its vitality and depth. The task that faces the interpreter is therefore to elucidate that tension and assess the alignment of forces between the two strands in his thought. An examination of the concept of magic in Freud's theory provides an opportunity to pursue this interpretive task. Although the Enlightenment position he often seems to embrace advocates the complete elimination of magic, many "magical" elements remain in his theory and clinical practice. Nor should this situation be deplored, for the ambition to completely exorcise "enchantment" from human experience is one of the misguided excesses of the Enlightenment. The question of an appropriate fate for magic in psychoanalysis is discussed in relation to the vicissitudes of the transference. Finally, the science versus hermenueutics debate is examined in the light of these considerations in an attempt to specify the unique nature of the psychoanalytic experience.     

On ethical issues at the foundation of the debate over the goals of psychoanalysis

In this paper the author points to ethical issues that underlie the debate over the nature of the goals of psychoanalysis. While it has been suggested that the lack of consensus and clarity in this debate may be partially explained in terms of opposing attitudes to the importance of therapeutic benefit and variance in core values of analysts and patients, the author shows that these explanations do not fully resolve the ambiguity. The examination of the limitations of the existing explanations points to the value of introducing an ethical dimension. She discusses two ethical issues: the complex nature of the ethical value of self-determination in psychoanalysis, and the ethical status of analytic change. The clarification of these two issues contributes to an understanding both of the inherently controversial nature of the debate over analytic goals, and of the place of ethical considerations in psychoanalytic theory and practice.     

The role of reality testing in psychoanalysis: followup of 22 cases

As part of a prospective, longitudinal study of psychoanalytic outcome, 22 patients were evaluated for changes in their level of reality testing. These patients had been accepted for supervised psychoanalysis with candidates in training by senior analysts who had diagnosed them as neurotic. Psychological tests given prior to the beginning of analysis indicated, however, that more than one third of our sample demonstrated serious distortions in their perceptions of reality. When psychological tests administered one year after the completion of analysis were compared with these pretreatment tests, no significant improvement was found in the level of reality testing for the group as a whole. However, when excluding two patients who had suffered major traumas in the year following psychoanalysis, significant improvement in reality testing was found for the remaining 20 patients. Post-treatment interviews with the treating analysts revealed that in the course of analysis itself, approximately one third of these patients showed some disturbance in reality testing; only three of these patients showed significant improvement in the level of their reality testing during treatment. These findings suggest that while patients may not present clinically with evidence of impaired reality testing, such evidence may be available in psychological testing, and may become apparent in the course of the treatment.     

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.