The questions and curiosity of the psychoanalyst

Questions the analyst asks of the patient are a powerful but neglected aspect of the theory of psychoanalytic technique. Their importance resides in their dynamic impact on the psychic equilibrium of the patient because of their ability to destabilize existing compromise formations. A clinical vignette illustrates the view that the linguistic shift from other modes of discourse to the spoken question heralds a less visible parallel shift in the psychic equilibrium of either the psychoanalyst or patient. There is no more and no less complexity to questions than to any other communication by either analyst or patient. For that reason there can be no systematic classification of questions in the clinical psychoanalytic situation, just as there can be no definitive taxonomy of psychoanalytic discourse. It makes no sense to reduce the enormous diversity and range of all the questions the analyst asks to the simple dichotomy of good or bad for the analysis. Questions are the emblem of the analyst's mode of inquiry; they can further the development of self-observation, which is such an important concomitant, cause, and consequence of structural change.     

Psychoanalytic controversies contextualized

Psychoanalytic disagreements are famously heated, polarized, and prolonged. These controversies are often the reflection of a shared agreement by the participants to engage in debate at an abstract level far removed from the clinical context in which the disagreement first arose. As a specimen example of such disputes, a case report by Patrick Casement is examined, together with a series of polemical discussions it inspired concerning physical contact suddenly demanded by an analysand in session. Over two dozen authors were almost evenly divided on whether to agree with Casement's technical conclusions, but showed a disquieting indifference to the detailed information available in his report regarding how this clinical crisis developed. The substantive merits of the contending arguments are not at issue; rather, the point is to demonstrate the crucial need to refine a methodology of contextualization to clarify inferential assumptions in clinical discussions. Premature truth claims might then give way to a more rational comparison of the clinical sources of divergent opinions. The term contextual horizon is introduced to facilitate an understanding of how the psychoanalyst makes inferences from the patient's associations.     

Why don't our institutes teach the methodology of clinical psychoanalytic evidence?

One of the most pressing theoretical, therapeutic, and educational problems confronting the advance of psychoanalysis is our confusion about the nature of clinical evidence. There is considerable disagreement among psychoanalysts about how to define evidence. Recently, there has also been a growing tendency toward evidential nihilism, justified by some of the more radical constructivist-narrative views of postmodern epistemology. Two surveys, conducted ten years apart, of all the psychoanalytic institutes recognized by the American Psychoanalytic Association, indicate a continuing and disturbing neglect of this topic in the curricula of our institutes. This paper reports the views of a number of psychoanalytic educators who participated in these surveys and is intended to stimulate discussion about the causes of this critical problem.