The analytic process in psychoanalysis and psychotherapy: from the interpersonal to the intrapsychic level

The current debate over the conflicting interpersonal and intrapsychic views of the analytic process may or may not help us to distinguish between psychoanalysis and analytic psychotherapy. A comparison of psychoanalysis in the English-speaking world--especially in the United States--with French psychoanalysis reveals the features that unite and at the same time divide these different psychoanalytical tendencies, both of which are the heirs to Freud's thought, in terms, in particular, of the setting (couch and chair) and of technique (interpretation, transference analysis and technical neutrality). Whereas all psychoanalytic work belongs within the framework of an interpersonal relationship, that relationship becomes meaningful only when linked to the intrapsychic dimension, which alone can open the way to the unconscious and to infantile sexuality.     

WHAT IS EFFECTIVE IN PSYCHOANALYTIC PSYCHOTHERAPY? A HISTORICAL REPRISE

While psychoanalysis as a field has moved from the ideal of technical neutrality to a vision of the therapist as more human, real, and empathically engaged, relatively little attention has been paid to the implications of this evolution. For Freud, technical neutrality provided an important protection against bias and suggestion, one problematized by a view of the psychoanalyst’s participation and influence as intrinsic to the therapeutic enterprise. The impact of this change on the evaluation of mechanisms of change is contextualized and discussed by the author.     

Becoming (and Remaining) an Analyst in Latin America

The following overview of the development of psychoanalysis in Brazil and in Porto Alegre outlines the current situation and the challenges to psychoanalysis in my country. I will explain my own experiences on becoming an analyst, the main reasons for my choice, my main influences, and my evolution as a clinical psychoanalyst and as a member of psychoanalytic and psychiatric institutions. I include my main contributions to psychoanalysis and consider two broad areas of interest: psychoanalytic technique and its teaching, and the relationship of psychoanalysis and culture. As for the former, my main interests are studies on countertransference and analytic neutrality, to which I will propose a comprehensive concept. As for the latter, I discuss a culture that contrasts vividly with the one in which Freud created the discipline, psychoanalytic views on violence and perversity, psychoanalytic institutions, and the application of analytic ideas for the understanding of some artists and their work.

I will also describe some general features of my country and the development of psychoanalysis in it; report my experiences as a candidate and an analyst; and offer some information about my evolution as an analyst through papers I have written over the past 30 years.     

Boundaries and intimacies: Ethics and the (re)performance of “The Law” in psychoanalysis

The notion of a boundary as it pertains to psychoanalysis is explored, and the distinctiveness of psychoanalysis as a healing science that is ethical and amoral is discussed. The difference between such a science and psychotherapies, which are committed to ideological ideals of maturation and adaptation, is elucidated. Five characteristics of psychological boundaries are discussed, and the significance of each individual's “encounter” with the incest taboo is elaborated, in terms of the dynamic formation of the repression barrier. In this context, the strict ethicality and moral neutrality of psychoanalytic practice is understood in terms of the emancipative way in which free-associative discourse works and plays along the repression barrier.     

Paradox and the repetitive search for the real reply to Ghent,Lachmann, and Russell

Linguistic philosophy provides conceptual tools by which psychoanalysis can redefine its conditions of productive discourse. In particular, the idea of performative contradictions permits ready noting of obstructions to that discourse.

The present paper means to develop an adequate vocabulary defining the conditions of what is essentially analytic and the positive events accompanying them. These conditions can be seen as systematic substitutions for such recommendations as anonymity and neutrality.     

Neutrality,tenderness and the analyst's subjectivity

Addressing the rôle of the analyst in the psychoanalytic relationship, the author takes issue with the emphasis on acknowledging the analyst's subjectivity and the critique of concepts like neutrality and abstinence as these issues are presented in the relational tradition. He advocates a better articulation and emphasis of these concepts in the service of understanding the impact of the analyst's subjectivity, and demonstrates how the mere loosening up of analytic neutrality and abstinence and an acceptance of the analyst's self-disclosure make transference analysis more difficult to handle. Such an attitude also increases the risk for ethically dubious conduct, since there is a close link between clinical methods and ethical standards in psychoanalysis. In conclusion, the author points to the importance of the analyst's continuous self-reflection and countertransference analysis.     

Finding the neutral position: patient and analyst perspectives

In light of current debates between classical and intersubjective schools of psychoanalysis, the challenge posed by the latter to such basic concepts as the analyst's neutrality, anonymity, and abstinence is taken up. It is maintained that the term neutral position is today more germane and meaningful than the term neutrality, which frequently has been taken to prescribe the analyst's posture. It is proposed that for each patient the neutral position is uniquely sited and that it is incumbent on the analyst to find its location. The neutral position is defined within the context of the interaction between analyst and patient. The concept is therefore compatible with--indeed it is essential to--an intersubjective or relational orientation. The manifold reasons, conscious and unconscious, why the analyst is vulnerable to leaving the neutral position are considered. The patient's reaction to the analyst who has left the neutral position and the analyst's clinical use of this reaction are discussed.     

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.     

Some hazards to neutrality in the psychoanalysis of candidates

The author looks at the challenges confronting psychoanalysts as they attempt to approach a desirable goal of neutrality in the treatment of psychoanalytic candidates and others who will become or are professional colleagues. Many such hazards are embedded in the interlocking relationships that inevitably exist between the analytic institute and its personnel, its training analysts, and its candidate-analysands. The author considers difficulties in the crucial analysis of aggression in training analyses. The analysis of aggression plays a determinative role in the personal and professional lives of analysands, and vitally affects the health and creativity of analytic institutions and the future of psychoanalysis.     

Regulation and standards for psychoanalysis: The place of the Other in psychoanalysis and its teaching

In numerous Western countries, psychotherapies have come under increasing governmental regulation. A more recent development is the increasing scrutiny given to psychoanalysis in the United Kingdom, in France, and in the United States. This paper examines a particular document that was created by four professional psychoanalytic organizations that are based in the United States. The document called Standards of Psychoanalytic Education aims to develop criteria that would guide accreditation and the organization of psychoanalytic institutes. The document is part of a set of concerns and actions related to the state regulation of psychoanalytic practice, its professional status, and the protection of those who seek its services. The essay examines the putative theoretical neutrality of this document by unfolding its tenets in terms of Lacanian psychoanalysis, a school of psychoanalysis that would take exception to many of the ideas suggested in the document's template for psychoanalytic education. The paper follows one line of argumentation throughout: what is the place of the Social Field, the Symbolic Other, within psychoanalytic process and as a recourse for professional legitimization that stands outside of psychoanalysis? As a practice of particularity, what relation does the discipline bear to other mental health fields and to the norms and knowledge systems of the mental health professions? Using a Lacanian orientation, two senses of the Other are discussed, and the specificity of psychoanalysis is asserted. This specificity is contrasted with some of the goals and constraints that are introduced by current approaches to regulation.      

Self-Disclosure and the Therapeutic Frame: Concerns for Novice Practitioners

Under the influence of the intersubjective or relational perspective, guidelines for establishing the therapeutic frame in psychoanalysis and psychoanalytic psychotherapy are undergoing modification. Therapeutic interventions such as disclosing subjective reactions have a sound theoretical basis, but they must be executed judiciously within a context of general neutrality, anonymity, and abstinence. Novice practitioners ought not attempt the more difficult relational interventions until they have acquired experience and security in the basic tenets of psychoanalytic practice, including how to maintain the traditional therapeutic frame. Inexperience in knowing when and under what circumstances to attempt self-disclosure of therapist affect, and insecurity in examining one's countertransference, have the potential to exacerbate enactments and entanglements for beginning therapists, as is illustrated in a case example.     

Patients’ Pregnancies During Treatment: The Influence of the Analyst’s Psychology

Psychoanalytic therapists are today far more aware of countertransference effects, intersubjectivity, and mutual influence. The area that has been explored least in this two-person appreciation of psychoanalytic process is the effect of the psychodynamics of the therapist in a wide sense—that is, how the therapist brings a whole psychology, with a wide array of potential transferences, to each treatment. Triggered by the unexpected announcement of a patient’s expecting a baby, the author reviewed his practice and found that a large portion of his women patients ages 30–45 had become pregnant during therapy or psychoanalysis. The particulars were varied: how much the patient wanted a baby, whether the treatment was psychotherapy or psychoanalysis, the patients’ personality structure. Was the analyst’s psychology a common factor? The paper presents three quite different case examples and examines whether and how the author’s developmental and inner experience of women, sexuality, pregnancy could have contributed to a dyadic process that, in turn, could lead to pregnancy. If such effects happen, then it is important to look beyond and behind “anonymity” and “neutrality,” as well as momentary countertransferences, to the real-life effects that we have in our treatments.     

Naming the Unnameable

An analogy is drawn between the naming of preverbal mental constellations and the intrusion on aboriginal fixed beliefs and rituals. In order to interpret the unnamed complexes, we must venture past many personal taboos and time our interventions, taking care to secure a workable alliance. A review of current practices in psychoanalysis shows many breaches in the older requirement of neutrality in the name of empathy, alliance, and intersubjectivity. Nonetheless the verbalization of unconscious patterned behaviors must be rendered in words and mentalized, if patients are to proceed in life with fewer restraints.

Naming the unconscious fantasies designates the patient's psychic reality. The factual basis of psychic reality as memories of the past remains uncertain.     

Beyond pluralism: psychoanalysis and the workings of mind

Subjects that Freud excluded or incompletely explored have been sites of theoretical expansion in over a century of observation: the role of the other, the self, the preoedipal period, action, the countertransference, limits to neutrality/anonymity/abstinence, the loci of the analytic drama, effects beyond interpretation, agency, and basic needs (versus wishes). These developments have led to conflicting theories and sect-like groupings within the field. Group psychological processes underlying this are discussed; and a broad and inclusive view of psychoanalysis is proposed under the heading of the study of the workings of mind. Additionally, substantial integrative proposals are offered with respect to the central tasks of individual development, theories of mind, the relational turn, and aspects of technique.     

Clinical Flexibility in the Psychoanalytic Situation: The Elasticity Principle

Abstract

This paper explores the development of the Elasticity Principle, first introduced by Ferenczi based upon his clinical observations. This important shift away from classical neutrality was inspired by Ferenczi's human approach to psychoanalysis. Learning from his analysands, he not only determined that in order to reduce resistances the analyst should present any interpretations in a tactful, empathetic manner, but also that the analytic work should bend or yield toward the analysand. The paper traces the evolution of the Elasticity Principle to The Grand Experiment, which was Ferenczi's analysis of Elizabeth Severn utilizing provision as an analytic tool. The paper follows the contemporary extensions of the Elasticity Principle in the development of Self Psychology and in the Relational perspective. A clinical example illuminates aspects of the Elasticity Principle in the work with a difficult analysand.     

The Mastery of Countertransference or Mynothaur's Labyrinth

This paper considers the fundamental change introduced by Ferenczi in 1919 by proposing the use of countertransference as an instrument. Basically it reconsiders the concept of analytic neutrality; mastery of countertransference is reached through tolerating it, overcoming resistances against it, demanding a very intense involvement of the analyst, as opposed to the image of the surgeon or the mirror. The paper analyzes the implications of this position for psychoanalysis. It places these concepts in the scientific and personal context in which it was written, then follows the later developments of these ideas in Ferenczi's own work, as well as in that of some other authors, and comments on the effects of these ideas on the psychoanalytic movement. Finally it poses some questions regarding our present use of countertransference in clinical work, with two brief vignettes highlighting these points.     

Countertransference and changes in the conception of the psychoanalytic relationship

Abstract

The concept of countertransference has a long history in psychoanalysis. This paper sketches the phenomenon referred to by countertransference and the development of the concept, from being signs of disturbance in the analyst to an important road to knowledge about the patient's inner life. The complexity of the questions discussed today – how to understand the concepts of neutrality, abstinence, and empathy; the relative subjective mutuality and symmetry of the analytic situation; the analyst's enactments and self-disclosure of feelings – reflects the complexity of the contemporary view of the patient–analyst relationship. In conclusion, the author presents a model illustrating the disturbing and informative aspects of countertransference together with the conceptual relationship between countertransference on the one hand and empathy and projective identification on the other. Finally, by differentiating between intuitive and irrational levels of functioning, an integrated model for countertransference is presented, synthesising the essence of the concept as it is used today.     

PSYCHOANALYSIS IN SCANDINAVIA: PART ONE

During recent years, the neurosciences have entered into a dialogue with psychoanalysis, which has opened new perspectives for their integration. Despite these developments, reservations remain concerning the reducing effects of the neurosciences by overtly or covertly hiding the core elements of psychoanalysis. However, Freud made an explicit parallel between psychoanalysis and physics in their relationship with the unknown reality, and in their task of filling in gaps in knowledge. Freud's epistemological view implies that the relationship with the unknown reality unites rather than separates psychoanalysis from other sciences. On the other hand, in the clinical realm, Freud emphasized the autonomy of psychoanalysis. Instead of offering causal explanations, the value of the neurosciences to psychoanalysis depends on how well the knowledge derived from them can be integrated in psychoanalysis and given a clinical meaning. The primacy of clinical relevance also pertains to the findings of empirical outcome research.     

精神分析在日本的传播与发展

综述了精神分析在日本的传入与发展。包括:(1)精神传入日本的历史轨迹,如心理学、精神医学、文化学视角的传播;(2)精神分析在日本的发展,如精神分析疗法的推广,精神分析理论的运用;(3)日本对精神分析的评价。     

Should Psychoanalysis Become a Science?

I wish to formulate in broad outline an approach to the conceptualization of psychoanalysis that is divested from theory. This view sees the core of psychoanalysis as a humanistic practice, first and foremost guided by the individuality of the dyadic encounter, rather than as a science. I will not argue for any particular view of psychoanalysis. Instead I marshal a series of considerations from the humanities, to frame a conceptualization of psychoanalysis as a clinically based interpretive discipline having a unique mission. Finally, I will present a futuristic hypothetical scenario whose aim is to show why psychoanalysis will remain a viable enterprise basically as conceived by Freud.