Excerpts from Must Read Books & Articles
on Mental Health Topics
Articles- Part XVI
Constructions in Analysis
Sigmund Freud (1937)
It has always seemed to me to be greatly to the credit of a certain
well-known man of science that he treated psychoanalysis fairly at
a time when most other people felt themselves under no such obligation.
On one occasion, nevertheless, he gave expression to an opinion upon
analytic technique which was at once derogatory and unjust. He said
that in giving interpretations to a patient we treat him upon the
famous principle of "Heads I win, tails you lose." That
is to say, if the patient agrees with us, then the interpretation
is right; but if he contradicts us, that is only a sign of his resistance,
which again shows that we are right. In this way we are always in
the right against the poor helpless wretch whom we are analysing,
no matter how he may respond to what we put forward. Now, since it
is in fact true that a "No" from one of our patients is
not as a rule enough to make us abandon an interpretation as incorrect,
a revelation such as this of the nature of our technique has been
most welcome to the opponents of analysis. It is therefore worthwhile
to give a detailed account of how we are accustomed to arrive at an
assessment of the "Yes" or "No" of our patients
during analytic treatment--of their expression of agreement or of
denial. The practising analyst will naturally learn nothing in the
course of this apologia that he does not already know.
It is familiar ground that the work
of analysis aims at inducing the patient to give up the repressions
(using the word in the widest sense) belonging to his early life and
to replace them by reactions of a sort that would correspond better
to a psychically mature condition. It is with this purpose in view
that he must be got to recollect certain experiences and the emotions
called up by them which he has at the moment forgotten. We know that
his present symptoms and inhibitions are the consequences of repressions
of this kind: that is, that they are a substitute for these things
that he has forgotten. What sort of material does he put at our disposal
which we can make use of to put him on the way to recovering the lost
memories? All kinds of things. He gives us fragments of these memories
in his dreams, invaluable in themselves but seriously distorted as
a rule by all the factors concerned in the formation of dreams. Again,
he produces ideas, if he gives himself up to "free association,"
in which we can discover allusions to the repressed experiences and
derivatives of the suppressed emotions as well as of the reactions
against them. And finally, there are hints of repetitions of the affects
belonging to the repressed material to be found in actions performed
by the patient, some important, some trivial, both inside and outside
the analytic situation. Our experience has shown that the relation
of transference, which becomes established towards the analyst, is
particularly calculated to favour the reproduction of these emotional
connections. It is out of such raw material--if we may so describe
it--that we have to put together what we are in search of.
What we are in search of is a picture
of the patient's forgotten years that shall be alike trustworthy and
in all essential respects complete. But at this point we are reminded
that the work of analysis consists of two quite different portions,
that it is carried on in two separate localities, that it involves
two people, to each of whom a distinct task is assigned. It may for
a moment seem strange that such a fundamental fact should not have
been pointed out long ago; but it will immediately be perceived that
there was nothing being kept back in this, that it is a fact which
is universally known and even self-evident and is merely being brought
into relief here and separately examined for a particular purpose.
We all know that the person who is being analysed has to be induced
to remember something that has been experienced by him and repressed;
and the dynamic determinants of this process are so interesting that
the other portion of the work, the task performed by the analyst,
has been pushed into the background. The analyst has neither experienced
nor repressed any of the material under consideration: his task cannot
be to remember anything. What then is his task? His task is to make
out what has been forgotten from the traces which it has left behind
or, more correctly, to construct it. The time and manner in
which he conveys his constructions to the person who is being analysed,
as well as the explanations with which he accompanies them, constitute
the link between the two portions of the work of analysis, between
his own part and that of the patient.
His work of construction, or, if it
is preferred, of reconstruction, resembles to a great extent an archaeologist's
excavation of some dwelling-place that has been destroyed and buried
or of some ancient edifice. The two processes are in fact identical,
except that the analyst works under better conditions and has more
material at his command to assist him, since what he is dealing with
is not something destroyed but something that is still alive--and
perhaps for another reason as well. But just as the archaeologist
builds up the walls of the building from the foundations that have
remained standing, determines the number and position of the columns
from depressions in the floor and reconstructs the mural decorations
and paintings from the remains found in the debris, so does the analyst
proceed when he draws his inferences from the fragments of memories,
from the associations and from the behaviour of the subject of the
analysis. Both of them have an undisputed right to reconstruct by
means of supplementing and combining the surviving remains. Both of
them, moreover, are subject to many of the same difficulties and sources
of error. One of the most ticklish problems that confronts the archaeologist
is notoriously the determination of the relative age of his finds;
and if an object makes its appearance in some particular level, it
often remains to be decided whether it belongs to that level or whether
it was carried down to that level owing to some subsequent disturbance.
It is easy to imagine the corresponding doubts that arise in the case
of analytic constructions.
The analyst, as we have said, works
under more favourable conditions than the archaeologist since he has
at his disposal material which can have no counterpart in excavations,
such as the repetitions of reactions dating from infancy and all that
emerges in connection with these repetitions through the transference.
But in addition to this it must be borne in mind that the excavator
is dealing with destroyed objects of which large and important portions
have quite certainly been lost, by mechanical violence, by fire and
by plundering. No amount of effort can result in their discovery and
lead to their being united with the surviving fragments. The one and
only course left open is that of reconstruction, which for this very
reason can often reach only a certain degree of probability. But it
is different with the psychical object whose early history the analyst
is seeking to recover. Here we are regularly met by a situation which
in archaeology occurs only in such rare circumstances as those of
Pompeii or of the tomb of Tutankhamen. All of the essentials are preserved,
even things that seem completely forgotten are present somehow and
somewhere, and have merely been buried and made inaccessible to the
subject. Indeed, it may, as we know, be doubted whether any psychical
structure can really be the victim of total destruction. It depends
only upon analytic technique whether we shall succeed in bringing
what is concealed completely to light. There are only two other facts
that weigh against the extraordinary advantage which is thus enjoyed
by the work
of analysis: namely, that psychical objects are incomparably more
complicated than the excavator's material ones and that we have insufficient
knowledge of what we may expect to find, since their finer structure
contains so much that is still mysterious. But our comparison between
the two forms of work can go no further than this; for the main difference
between them lies in the fact that for the archaeologist the reconstruction
is the aim and end of his endeavours while for analysis the construction
is only a preliminary labour.
It is not, however, a preliminary labour in the sense that the whole
of it must be completed before the next piece of work can be begun,
as, for instance, is the case with housebuilding, where all the walls
must be erected and all the windows inserted before the internal decoration
of the rooms can be taken in hand. Every analyst knows that things
happen differently in an analytic treatment and that there both kinds
of work are carried on side by side, the one kind being always a little
ahead and the other following upon it. The analyst finishes a piece
of construction and communicates it to the subject of the analysis
so that it may work upon him; he then constructs a further piece out
of the fresh material pouring in upon him, deals with it in the same
way and proceeds in this alternating fashion until the end. If, in
accounts of analytic technique, so little is said about "constructions,"
that is because "interpretations" and their effects are
spoken of instead. But I think that "construction" is by
far the more appropriate description. "Interpretation" applies
to something that one does to some single element of the material,
such as an association or a parapraxis. But it is a "construction"
when one lays before the subject of the analysis a piece of his early
history that he has forgotten, in some such way as this: "Up
to your nth year you regarded yourself as the sole and unlimited possessor
of your mother; then came another baby and brought you grave disillusionment.
Your mother left you for some time, and even after her reappearance
she was never again devoted to you exclusively. Your feelings towards
your mother became ambivalent, your father gained a new importance
for you,". . . and so on.
In the present paper our attention will
be turned exclusively to this preliminary labour performed by constructions.
And here, at the very start, the question arises of what guarantee
we have while we are working on these constructions that we are not
making mistakes and risking the success of the treatment by putting
forward some construction that is incorrect. It may seem that no general
reply can in any event be given to this question; but even before
discussing it we may lend our ear to some comforting information that
is afforded by analytic experience. For we learn from it that no damage
is done if, for once in a way, we make a mistake and offer the patient
a wrong construction as the probable historic truth. A waste of time
is, of course, involved, and anyone who does nothing but present the
patient with false combinations will neither create a very good impression
on him nor carry the treatment very far; but a single mistake of the
sort can do no harm. What in fact occurs in such an event is rather
that the patient remains as though he were untouched by what has been
said and reacts to it with neither a "Yes" nor a "No."
This may possibly mean no more than that his reaction is postponed;
but if nothing further develops we may conclude that we have made
a mistake and we shall admit as much to the patient at some suitable
opportunity without sacrificing any of our authority. Such an opportunity
will arise when some new material has come to light which allows us
to make a better construction and at the same time to correct our
error. In this way the false construction drops out, as if it had
never been made; and, indeed, we often get an impression as though,
to borrow the words of Polonius, our bait of falsehood had taken a
carp of truth. The danger of our leading a patient astray by suggestion,
by persuading him to accept things which we ourselves believe but
which he ought not to, has certainly been enormously exaggerated.
An analyst would have had to behave very incorrectly before such a
misfortune could overtake him; above all, he would have to blame himself
with not allowing his patients to have their say. I can assert without
boasting that such an abuse of "suggestion" has never occurred
in my practice.
It already follows from what has been
said that we are not at all inclined to neglect the indications that
can be inferred from the patient's reaction when we have offered him
one of our constructions. The point must be gone into in detail. It
is true that we do not accept the "No" of a person under
analysis at its face value; but neither do we allow his "Yes"
to pass. There is no justification for accusing us of invariably twisting
his remarks into an assent. In reality things are not so simple and
we do not make it so easy for ourselves to come to a conclusion.
A plain "Yes" from a patient
is by no means unambiguous. It can indeed signify that he recognizes
the correctness of the construction that has been presented to him;
but it can also be meaningless, or can even deserve to be described
as "hypocritical," since it may be convenient for his resistance
to make use of an assent in such circumstances in order to prolong
the concealment of a truth that has not been discovered. The "Yes"
has no value unless it is followed by indirect confirmations, unless
the patient, immediately after his "Yes," produces new memories
which complete and extend the construction. Only in such an event
do we consider that the "Yes" has dealt completely with
the subject under discussion.
A "No" from a person in analysis
is no more unambiguous than a "Yes," and is indeed of even
less value. In some rare cases it turns out to be the expression of
a legitimate dissent. Far more frequently it expresses a resistance
which may have been evoked by the subject-matter of the construction
that has been put forward but which may just as easily have arisen
from some other factor in the complex analytic situation. Thus, a
patient's "No" is no evidence of the correctness of a construction,
though it is perfectly compatible with it. Since every such construction
is an incomplete one, since it covers only a small fragment of the
forgotten events, we are free to suppose that the patient is not in
fact disputing what has been said to him but is basing his contradiction
upon the part
that has not yet been discovered. As a rule he will not give his assent
until he has learnt the whole truth--which often covers a very great
deal of ground. So that the only safe interpretation of his "No"
is that it points to incompleteness; there can be no doubt that the
construction has not told him everything.
It appears, therefore, that the direct
utterances of the patient after he has been offered a construction
afford very little evidence upon the question whether we have been
right or wrong. It is of all the greater interest that there are indirect
forms of confirmation which are in every respect trustworthy. One
of these is a form of words that is used (almost as though there were
a conspiracy) with very little variation by the most different people:
"I've never thought (or, I should never have thought) that (or,
of that)." This can be translated without any hesitation into:
"Yes, you're right this time--about my unconscious."
Unfortunately this formula which is so welcome to the analyst, reaches
his ears more often after single interpretations than after he has
produced an extensive construction. An equally valuable confirmation
is implied (expressed this time positively) when the patient answers
with an association which contains something similar or analogous
to the subject-matter of the construction. Instead of taking an example
of this from an analysis (which would be easy to find but lengthy
to describe) I prefer to give an account of a small extra-analytical
experience which presents a similar situation so strikingly that it
produces an almost comic effect. It concerned one of my colleagues
who--it was long ago--had chosen me as a consultant in his medical
practice. One day, however, he brought his young wife to see me, as
she was causing him trouble. She refused on all sorts of pretexts
to have sexual relations with him, and what he expected of me was
evidently that I should lay before her the consequences of her ill-advised
behaviour. I went into the matter and explained to her that her refusal
would probably have unfortunate results for her husband's health or
would lay him open to temptations that might lead to a breakup of
their marriage. At this point he suddenly interrupted me with the
remark: "The Englishman you diagnosed as suffering from a cerebral
tumour has died too." At first the remark seemed incomprehensible;
the "too" in his sentence was a mystery, for we had not
been speaking of anyone else who had died. But a short time afterwards
I understood. The man was evidently intending to confirm what I had
been saying; he was meaning to say: "Yes, you're certainly quite
right. Your diagnosis was confirmed in the case of the other patient
too." It was an exact parallel to the indirect confirmations
that we obtain in analysis from associations. I will not attempt to
deny that there were other thoughts as well, put on one side by my
colleague, which had a share in determining his remark.
Indirect confirmation from associations
that fit in with the content of a construction--that give us a "too"
like the one in my story--provide a valuable basis for judging whether
the construction is likely to be confirmed in the course of the analysis.
It is particularly striking when a confirmation of this kind slips
into a direct denial by means of a parapraxis. I once published elsewhere
a nice example of this. The name "Jauner" (a familiar one
in Vienna) came up repeatedly in one of my patient's dreams without
a sufficient explanation appearing in his associations. I finally
put forward the interpretation that when he said "Jauner"
he probably meant "Gauner" [swindler], whereupon he promptly
replied: "That seems to me too 'jewagt' [instead of 'gewagt'
(farfetched)]." Or there was the other instance, in which, when
I suggested to a patient that he considered a particular fee too high,
he meant to deny the suggestion with the words "Ten dollars mean
nothing to me" but instead of dollars put in a coin of lower
denomination and said "ten shillings."
If an analysis is dominated by powerful
factors that impose a negative therapeutic reaction, such as a sense
of guilt, a masochistic need for suffering or a striving against receiving
help from the analyst, the patient's behaviour after he has been offered
a construction often makes it very easy for us to arrive at the decision
that we are in search of. If the construction is wrong, there is no
change in the patient; but if it is right or gives an approximation
to the truth, he reacts to it with an unmistakable aggravation of
his symptoms and of his general condition.
We may sum the matter up by asserting
that there is no justification for the reproach that we neglect or
underestimate the importance of the attitude taken up by those under
analysis towards our constructions. We pay attention to them and often
derive valuable information from them. But these reactions on the
part of the patient are rarely unambiguous and give no opportunity
for a final judgement. Only the further course of the analysis enables
us to decide upon the correctness or uselessness of our constructions.
We do not pretend that an individual construction is anything more
than a conjecture which awaits examination, confirmation or reaction.
We claim no authority for it, we require no direct agreement from
the patient, nor do we argue with him if at first he denies it. In
short, we conduct ourselves upon the model of a familiar figure in
one of Nestroy's farces--the man-servant who has a single answer on
his lips to every question or objection: "All will become clear
in the course of future developments."
It is hardly worth while describing how this occurs in the process
of the analysis--the way in which our conjecture is transformed into
the patient's conviction. All of this is familiar to every analyst
from his daily experience and is intelligible without difficulty.
Only one point requires investigation and explanation. The path that
starts from the analyst's construction ought to end in the patient's
recollection; but it does not always lead so far. Quite often we do
not succeed in bringing the patient to recollect what has been repressed.
Instead of that, if the analysis is carried out correctly, we produce
in him an assured conviction of the truth of the construction which
achieves the same therapeutic result as a recaptured memory. The problem
of what the circumstances are in which this occurs and of how it is
possible that what appears to be an incomplete substitute should nevertheless
produce a complete result--all of this is material for a later enquiry.
I shall conclude this brief paper with
a few remarks which open up a wider perspective. I have been struck
by the manner in which, in certain analyses, the communication of
an obviously apt construction has evoked in the patients a surprising
and at first incomprehensible phenomenon. They have had lively recollections
called up in them--which they themselves have described as "unnaturally
distinct"--but what they have recollected has not been the event
that was the subject of the construction but details relating to that
subject. For instance, they have recollected with abnormal sharpness
the faces of the people involved in the construction or the rooms
in which something of the sort might have happened, or, a step further
away, the furniture in such rooms--on the subject of which the construction
had naturally no possibility of any knowledge. This has occurred both
in dreams immediately after the construction had been put forward
and in waking states in the nature of a day-dream. These recollections
have themselves led to nothing further and it has seemed plausible
to regard them as the product of a compromise. The "upward drive"
of the repressed, stirred into activity by the putting forward of
the construction, has striven to carry the important memory-traces
into consciousness; but a resistance has succeeded--not, it is true,
in stopping that movement--but in displacing it on to adjacent objects
of minor significance.
These recollections might have been
described as hallucinations if a belief in their actual presence had
been added to their clearness. The importance of this analogy seemed
greater when I noticed that true hallucinations occasionally occurred
in the case of other patients who were certainly not psychotic. My
line of thought proceeded as follows. Perhaps it may be a general
characteristic of hallucinations to which sufficient attention has
not hitherto been paid that in them something that has been experienced
in infancy and then forgotten reemerges--something that the child
has seen or heard at a time when he could still hardly speak and that
now forces its way into consciousness, probably distorted and displaced
owing to the operation of forces that are opposed to this re-emergence.
And, in view of the close relation between hallucinations and particular
forms of psychosis, our line of thought may be carried still further.
It may be that the delusions into which these hallucinations are so
constantly incorporated may themselves be less independent of the
upward drive of the unconscious and the return of the repressed than
we usually assume. In the mechanism of a delusion we stress as a rule
only two factors: the turning away from the real world and its forces
on the one hand and the influence exercised by wish fulfilment upon
the subject-matter of the delusion on the other. But may it not be
that the dynamic process is rather that the turning away from reality
is exploited by the upward drive of the repressed in order to force
its subject-matter into consciousness, while the resistances stirred
up by this process and the impulse to wish-fulfilment share the responsibility
for the distortion and displacement of what is recollected? This is
after all the familiar mechanism of dreams, which intuition has equated
with madness from time immemorial.
This view of delusions is not, I think,
entirely new, but it nevertheless emphasizes a point of view which
is not usually brought into the foreground. The essence of it is that
there is not only method in madness, as the poet has already
perceived, but also a fragment of historic truth; and it is plausible
to suppose that the compulsive belief attaching to delusions derives
its strength precisely from infantile sources of this kind. All that
I can produce today in support of this theory are reminiscences, not
fresh impressions. It would probably be worth while to make an attempt
to study cases of the disorder in question on the basis of the hypotheses
that have been here put forward and also to carry out their treatment
upon the same lines. The vain effort would be abandoned of convincing
the patient of the error of his delusion and of its contradiction
of reality; and, on the contrary, the recognition of its kernel of
truth would afford common ground upon which the therapeutic process
could develop. That process would consist in liberating the fragment
of historic truth from its distortions and its attachments to the
actual present day and in leading it back to the point in the past
to which it belongs. The transposing of material from a forgotten
past on to the present or on to an expectation of the future is indeed
a habitual occurrence in neurotics no less than in psychotics. Often
enough, when a neurotic is led by an anxiety-state to expect the occurrence
of some terrible event, he is in fact merely under the influence of
a repressed memory (which is seeking to enter consciousness but cannot
become conscious) that something which was at that time terrifying
did really happen. I believe that we should gain a great deal of valuable
knowledge from work of this kind upon psychotics even if it led to
no therapeutic success.
I am aware that it is of small service
to handle so important a subject in the cursory fashion that I have
here employed. But none the less I have not been able to resist the
seduction of an analogy. The delusions of patients appear to me to
be the equivalents of the constructions which we build up in the course
of an analytic treatment--attempts at explanations and cure, though
it is true that these, under the conditions of a psychosis, can do
no more than replace the fragment of reality that is being repudiated
in the present by another fragment that had already been repudiated
in the remote past. It will be the task of each individual investigation
to reveal the intimate connections between the material of the present
repudiation and that of the original repression. Just as our construction
is only effective because it recovers a fragment of lost experience,
so the delusion owes its convincing power to the element of historic
truth which it inserts in the place of rejected reality. In this way
a proposition which I originally asserted only of hysteria would apply
also to delusions--namely, that those who are subject to them are
suffering from their own recollections. I never intended by this short
formula to dispute the complexity of the causation of the illness
or to exclude the operation of many other factors.
If we consider mankind as a whole and
substitute it for the single human individual, we discover that it
too has developed delusions which are inaccessible to logical criticism
and which contradict reality. If, in spite of this, they are able
to exert an extraordinary power over men, investigation leads us to
the same explanation as in the case of the single individual. They
owe their power to the element of historic truth which they have brought
up from the repression of the forgotten and primaeval past.
What is Psychoanalysis? How does it Work?
Murray Meisels (Paper presented to the Michigan Psychoanalytic Council
What is Psychoanalysis?
Psychoanalysis has been defined in numerous ways. Merton Gill, a classical
analyst then at the Menninger Clinic, defined psychoanalysis during
the post-war period as a theory of personality, a method of research,
and a mode of treatment. As a treatment, he stated that it required
4x or 5x sessions a week on the couch during which the analysand would
reexperience infantile material, develop a transference, and resolve
it by using the analyst's interpretations. Several decades later,
while living in Chicago, he changed his mind and said that any treatment
that dealt with transference was psychoanalytic, even if it occurred
once a week. With that latter definition, many critics thought that
he had moved outside of the field of psychoanalysis. However, I find
both definitions useful, depending on circumstances.
I have also favored Karen Horney's (1939)
definition. Horney was a German psychoanalyst from Berlin who emigrated
to America and evolved her own theories starting in the 1930's. Generally
regarded as a culturalist, she considered that psychoanalytic theories
entailed a theory of personality, a focus on early childhood and developmental
influences, an appreciation of the role of unconscious factors, some
theory of conflict, anxiety and defense, and a method of treatment.
In the early 1980's I helped conduct a survey of the members of the
Division of Psychoanalysis of the American Psychological Association
(see Meisels and O'Dell, 1994). One of the questions was: What three
psychoanalytic concepts are most important to you? The three concepts
turned out to be transference and countertransference, development,
and treatment techniques. Thus, from an empirical point of view, psychoanalysts
could be defined as those people who are interested in the vagaries
of human relationships (transference and countertransference), in
development, and in psychological treatment.
A definition that recently caught my
fancy, however, is vastly different from these because it addresses
not the workaday psychoanalytic world but is a characterization of
psychoanalysis from an outsider's view. Douglas Kirsner, an Australian
historian, studied psychoanalytic institutes in the USA. His definition,
"Psychoanalysis is a humanistic discipline that is touted as
a science but is organized as a religion (2001, p. 195)." His
book, which summarizes his findings about the operation and structure
of four psychoanalytic institutes of the American Psychoanalytic Association
(APsaA), is called, Unfree Associations: Inside Psychoanalytic Institutes
(2000). Kirsner studied four of the premier institutes of ApsaA, those
in Boston, Chicago, Los Angeles and the New York Psychoanalytic in
New York.. What he found in all four was power politics and dogmatism.
Those institutes were controlled by a power elite who maintained a
particular ideology, dispersed cases and teaching privileges to their
own acolytes and adherents, and did not tolerate academic freedom
or dissent. Those younger colleagues and students who followed the
accepted ideology, and who diligently supported the leadership and
worked for the association, could work their way up the hierarchy
and eventually become training analysts. Only training analysts could
analyze candidates, and the status of training analyst was awarded
only to few institute analysts. In those institutes, the status of
training analyst was a virtual guarantee of financial and professional
success. According to Kirsner, the young analyst had to be politically
savvy and ideologically correct, had to play up to the powers that
be in order to advance, and had to maintain the accepted teachings
of his elders. Karen Horney, for example, had her teaching privileges
revoked at the New York Psychoanalytic Institute in about 1941 because
of the popularity and unorthodoxy of her ideas. Kirsner called these
institutes "Unfree Associations" because they were organizations
or associations of people who were not free to speak their minds or
think their thoughts. His profound argument is that the level of scientific
knowledge in psychoanalysis is very low, and that "quasireligious
thinking and politics" act as substitutes for scientific knowledge.
Thus, instead of ideas being supported by evidence, ideas attain a
status of truth via a pronouncement by a leading theorist, and those
psychoanalysts who disagree may be ostracized or denounced as being
antipsychoanalytic. When leaders of these associations came into conflict
with one another, the issues were not resolved by scientific study
but by political action. This quasireligious, political structure,
Kirsner argues, leads to schisms, processes of anointment, arbitrariness,
authoritarianism and the stifling of creativity.
Fortunately, ApsaA institutes are a
minority that comprise only 30 of the approximately 150 psychoanalytic
training institutes in the country (see Meisels, 2002). Kirstner did
not study any of the 120 or so free-standing institutes, most of which,
to this writer's knowledge, are not so religious in tone. There are
also other venues where psychoanalysis is taught, such as in universities,
clinics and hospitals, and those groups are generally not organized
in the cult-like, religious structure described by Kirsner. The Michigan
Psychoanalytic Council (MPC), our institute, is a good example of
a nonreligious organizational structure. In MPC, membership is open
to nonpsychoanalysts: They vote, hold office, read papers and participate
in the MPC's psychoanalytic life. Also, MPC does not designate a special
cadre of training analysts. Our graduates do not have to spend decades
ingratiating themselves in order to eventually analyze candidates.
In MPC all analysts are training analysts from the moment of graduation.
In my view, the policies of APsaA have generated an Oedipal structure
in which their sons and daughters are arbitrarily placed in a prolonged
state of helplessness and dependency, while MPC has avoided that Oedipal
structure and has not experienced the tyranny of gurus or religious
or internecine warfare. Yet, there is still a serious worry because
of the lack of a substantive scientific knowledge base. If the solution
to that lack in APsaA is dogma and religion, the solution in MPC it
to acknowledge our differences and to be tolerant of the diversity
of theoretical views amongst us.
Definition of Psychoanalysis
Building on Kirsner's definition, I define psychoanalysis as a psychoeducational
discipline that utilizes intense psychoeducational experiences, aspires
to be a science, is organized as an ideology, and has had a great
influence on the modern world. I shall elaborate on these in order.
First, a psychoeducational discipline. Kirsner say psychoanalysis
a humanistic discipline, but I prefer the term psychoeducational.
Humanistic sounds too free-floating, too abstract, a term more apt
to describe the humanities, the study of art, literature, or foreign
languages. Psychoeducational sounds like it can put both of its feet
on the ground, that it is practical; it is educational and psychological.
It involves intense psychoeducational experiences that provide understanding
and education of the psychological functioning of individuals. Psychoeducational
is rooted both in psychology, which has scientific aspects that are
subject to verification by research, and in education, which has as
its goal the progressive development of an individual. Unfortunately,
this latter is notoriously difficult to evaluate through research.
An alternative to psychoeducational might be the term psychotherapeutic,
that is, that psychoanalysis is a psychotherapeutic discipline, but
that seems too limiting. Psychotherapeutic refers to mental health
and illness, while psychoeducational refers to education and growth,
a broader dimension.
There is a common view that people who
seek psychotherapy and psychoanalysis suffer from various diagnosable
psychiatric syndromes, and that the treatment of such is the practice
of medicine. Indeed, when it comes to billing insurance companies,
we all adopt that definition. However, people use our treatments who
have no obvious diagnosable symptoms or syndromes. Nor do we directly
treat symptoms when people do present them: We talk about symptoms,
learn about them, and educate ourselves about them. Analogously, learning
yoga or tennis is not a medical treatment, and yet both may provide
the student with ample health benefits along with newfound physical
skills. That is what we do, provide ample psychological health benefits
along with newfound skills in teaching people to observe and understand
themselves and others.
While we may define ourselves as mental
health professionals for insurance-billing and licensing purposes,
we fundamentally function as psychoeducationalists. Insofar as we
define ourselves as mental health professionals, and operate under
state mental health licensing laws and collect insurance monies, so
are we subject to the pressures of government agencies and insurance
companies. Increasingly, this will mean justifying our practices by
research evidence of the effectiveness of psychoanalysis. The government
and insurance companies are trying to control medical costs by increasingly
insisting that treatments have evidence for their effectiveness. This
is the Achilles heal of psychoanalysis (see, e.g., Gray, 2002), as
well as many other treatments.
Second that psychoanalysis aspires to be a science. I shall start
with a brief sketch of the history of the attitude of psychoanalysis
towards science. For the first 70 or 80 years of its history psychoanalysts
viewed themselves as conducting scientific research in their consulting
rooms. Freud, Gill and many other considered the consulting room as
the place where psychoanalysts carried out research. Freud's writings
are filled with scientific references, and it is clear that he viewed
psychoanalysis as science. Sheila Hafter Gray (2002), in an article
entitled Evidence-Based Therapeutics that was published in 2002 in
the Journal of the American Academy of Psychoanalysis wrote:
"Freud was an avid contributor
to the medical literature of his day. In Studies in Hysteria (Breuer
& Freud, 1985) he and Breuer followed the case study model that
was practiced by every scientific physician and surgeon of their day
approach and his reporting style were not different from those of
his peers in other medical disciplines (p. 10)." Freud's writings
illustrate his view of psychoanalysis as science. Scientists collect
facts and produce theories about those facts. Freud's case histories
were clinical descriptions and his theories were his efforts to explain
his clinical findings. In addition to the case study method, Freud
described dreams, slips, wit, symptoms and associations to these phenomena.
Typically, Freud reviewed the extant scientific literature in any
given area, then presented his own data, and then his theorizing.
It was all empirical, although not experimental. Other early psychoanalysts
were similarly sure of the scientific nature of their work. They would
treat some kind of disorder, identify the dynamics, and publish it
as a scientific finding.
In 1945, Otto Fenichel published an encyclopedic work called The Psychoanalytic
Theory of Neurosis. His book summarized the extant Freudian literature
regarding many types of psychopathology. Fenichel followed Freud in
arguing that all forms of neurotic disturbance were libidinal in nature,
and emphasized the role of anxiety or fear in initiating and perpetuating
disorders. For example, in the chapter on obsessive-compulsive disorders
he spelled out a regression from Oedipal to anal sexuality, emphasized
the role of guilt as the major type of anxiety, and provided generous
descriptions and case histories regarding the observed obsessive-compulsive
defenses of isolation of affect, reaction formation, and undoing.
In this and many other writings psychoanalysts presented what they
considered to be a scientific theory of neurosis, of its etiology,
its features, and its dynamics. The point is that earlier generations
of psychoanalysts viewed themselves as doing scientific work, and
they believed that they had discovered and developed theories about
humankind's fundamental nature.
For many decades, through the 1970s,
psychoanalysis had a great impact on the field of psychology. It was
one of the two 'big' theories taught in graduate programs, the other
being behaviorism. Psychoanalytic ideas formed the basis for much
research, and clinical faculty and graduate students were often psychoanalytically
oriented. In the 1960s and early 1970s, this writer was one of those
academics who did research using psychoanalytic theory. Indeed, psychoanalytic
ideas led to many important research findings. An example is the work
of Rene Spitz (1946), who showed that a lack of mothering leads to
death or severe developmental impairment in infants. Similarly, John
Bowlby (1980) used cross species and observational data for this important
theories about attachment and loss. In Michigan, both Selma Freiberg
and Henry Krystal have provided research material and integrated psychoanalytic
thought into mainstream psychological theories.
End of phase one. Turn now to 1994,
by which time this situation had completely changed. I shall shortly
tell you why I chose the year 1994. First off, by 1994 it had long
been clear that the facts of psychoanalysis led to numerous theories,
and that the findings were themselves influenced by the viewpoint
of the analyst. As Michael Balint put it is book, The Basic Fault
(1968), Freudian patients dreamed about sex and uncovered Oedipal
complexes while Kleinian analysands dreamed about feeding and discovered
bad breasts. Freud wanted psychoanalysis to operate on the basis of
interpretation and not (dreaded) suggestion, but this may have reflected
his concern about and awareness of the analyst's actual contribution
to the analysis.
Second, science had changed. The case
study method, as compelling as it sometimes seems, came to be regarded
as an exploratory, hypothesis-generating method. The ideas derived
from case studies needed to be verified by the gold standard of experimental
research. For psychotherapy this meant random clinical trials using
double-blind controls. Gray, in her 2002 article, wrote about the
new demands from government and insurance companies for evidence-based
treatment, and she stated that psychoanalysis, along with many other
medical and psychological treatments, has never been tested by random
Third, by 1994 there were increasing
criticism that psychoanalysis was unscientific. The logic of some
of this criticism is compelling. One criticism is the indefiniteness
of some psychoanalytic concepts. For example, Freud said the deepest
fear of men was castration, yet many men do not manifest castration
anxiety. Undaunted by the lack of supporting evidence, some Freudians
redefined castration fear to mean other things, such that any failing
could be viewed as a castration equivalent, any threat as a castration
threat; vice versa, any success was viewed as proof that one has not
been castrated. Thus, where the data did not support the theory it
redefined itself on a slippery slope of changing meanings and downright
obfuscation, becoming a religious view rather that an scientific hypothesis.
Psychoanalysts didn't have a problem
with facts in the early years, but now many psychoanalysts have a
serious problem with them. Freud was quite clear about what the facts
were-dreams, slips, symptoms, associations, and case studies-but when
developments in science did not support and extend psychoanalytic
theory, the whole field seemed to change. Meaning and clarity were
lost. When the infant studies literature published results with contradicted
every psychoanalytic theory of infancy, some dismissed the findings.
Psychoanalysts had developed theories that babies had certain characteristics
or needs or experiences, but when the study of babies didn't support
their ideas, they dismissed the data! When John Bowlby published his
now-popular books on attachment and loss, his ideas were at first
dismissed by some psychoanalysts because they undermined psychoanalytic
theory. Ditto for Daniel Stern's work on infancy. At this time, some
psychoanalysts devalue findings in the new field of neuropsychoanalysis,
and yet others dislike the very concept of evolutionary psychology
or evolutionary psychoanalysis. Or that medications have been found
to be helpful, or that new findings report a genetic contribution
to obsessive-compulsive disorders. Some psychoanalysts have decried
efforts to build psychoanalysis on a foundation of facts and have
redefined the field as the study of hermeneutics, or intersubjectivity,
or personal history.
Now, to 1994. These problems with facts
achieved their most remarkable manifestation in the special 75th edition
of the International Journal of Psychoanalysis (IJP), published in
1994. The IJP is the official publication of the International Psychoanalytic
Association (IPA), which was founded by Freud to advance the field
of psychoanalysis. Most would call the IJP the most prestigious journal
in the field. The special 75th anniversary edition featured 29 papers
by distinguished psychoanalysts on the topic, What is a clinical fact
in psychoanalysis? Well, you might expect the usual material about
case studies, dreams, and slips, or maybe some findings from experimental
research, but there was hardly any of that. The issue contained 29
papers by 29 distinguished psychoanalysts who seemed to be ignorant
of and confused about science. These 29 psychoanalysts presented 29
different definitions of what clinical fact was, and no two definitions
were alike. In his introductory comments the editor of the journal
I assert that by and large our standards of observation,
of clarifying the distinction between observations and conceptualization,
and our standards for discussing and debating our observations are
extraordinarily low (Tuckett, 1984, p. 865)." In their totality,
these papers would indicate that there are no agreed upon facts in
psychoanalysis, only extreme subjectivism. Each of the 29 writers
had a theory, but there is no way to ever test their theories because
there is no agreement about those facts that might support or contradict
them. That issue of the IJP could be gleefully used by critics as
evidence that psychoanalysis is a pseudoscience. Are we entering a
religious phase of psychoanalytic history, as Kirsner in fact asserts?
In summary of this section, over the
last century psychoanalysis went from the offense to the defense.
At first, it made the discoveries that excited, upset and challenged
the Western world. Psychoanalysis was the cutting edge. From Freud's
libido theory to Fromm's marketing personality to Kohut's idealizing
transferences it was psychoanalysts who were making the innovations
and setting the agenda for psychotherapy, mental health and society.
Now, in contract, it is the DSMs, the cognitive behaviorists, and
the drug companies that define the mental health agenda. At the same
time, the efficacy and effectiveness of clinical psychoanalysis has
yet to be scientifically demonstrated with nontreatment controls,
let alone in comparison with alternative treatments.
Thus, psychoanalysis aspires to be a science, and manifests some scientific
aspects, but has a long way to go.
Third, psychoanalysis functions as an
ideology. I think that for MPC members psychoanalysis functions as
an organizing attitude, but with few or no religious overtones. For
many in MPC, psychoanalysis is a useful way of thinking about people.
It provides insightful and exciting ideas, helps people in understanding
and living their own lives, and is very useful for treatment. However
religious in tone it may be to some IPA and APsaA members, who seem
to manifest an ownership interest in psychoanalysis, I have not found
this to be the case in the Division of Psychoanalysis or MPC, or in
other non-APsaA institutes and groups that I am familiar with.
I very much admire the psychoanalytic
ideology, or at least my version of it. Namely, that things people
say and do have meaning, that people react consciously and unconsciously
to the events in their lives, that their lives reflect the influences
that have affected them, that the study of people and their lives
is a worthwhile project, and that understanding and insight lead to
greater self-awareness and to the ability to change. The whole of
human history has been affected by the very psychological issues and
patterns that we observe. For me, there is still a revolutionary aspect
to psychoanalysis, a sense of excitement, of surprise, of the unknown.
Fourth and lastly, that psychoanalysis
has had a great influence on the modern world. Early in the 20th century,
psychoanalysis was the only major psychological theory that attracted
intellectual interest in the general public. Its influence grew. Psychoanalytic
thinking permeated people's consciousness, and psychoanalytic ideas
were widely used even without mention of Freud. Concepts such as defense
mechanisms, unconscious wishes and psychodynamics flourished and influenced
many fields. Perhaps all developments in the broad field of psychotherapy
were initiated or influenced by Freud and other psychoanalysts. Numerous
academic disciplines utilized psychoanalytic ideas, including psychology,
psychiatry, social work, sociology, and anthropology. In the humanities
psychoanalysis influenced movies, literature, literary and artistic
criticism, biography, history, art and art criticism, political commentary,
and more, and has permeated social and intellectual thought. These
days I often hear people described as anal, or some dynamic or other
proffered by TV personalities or magazines to explain someone's behavior.
For example, the recent war in Iraq was widely interpreted as an effort
by President Bush to undo his father's error in the prior Gulf War,
what might be called a manifest content interpretation..
Here is an oddball effect of psychoanalysis
in the social sphere, one that even psychoanalysts might initially
find hard to recognize. It happened after WWII, when Revlon, the cosmetics
company, was having trouble selling some lipstick. It so happened
that they asked a psychoanalytic psychologist from the Frankfort School,
whose name I forget, to see if she could figure out why this was so.
Why wasn't the lipstick selling? This psychologist utilized established
psychoanalytic technique in a novel way in order to answer this question.
What she did was to place a group of women in a room and had them
free associate, brainstorm, about Revlon lipstick, and what they did
and didn't like about it. This differed from psychoanalysis because
the purpose of the associations was not to find our about the meaning
of the topic to the individual, but about the meaning of the topic
in itself (its unconscious pull). This technique is now called the
focus group. The focus group is psychoanalysis applied to social goods.
Ever since I relearned about the Revlon story, which I knew in college,
I have been interested in how pollsters talk about and interpret the
results of their focus groups, as evidenced in political talk shows.
Prior to the 2002 election Democratic pollsters found that at the
deepest level the Democrats were leading or closing the gap quickly,
the exact reverse of what the Republican pollsters found. This is
analogous to Adlerians uncovering feelings of inferiority and Jungians
finding the shadow. The discussions among pollsters about the most
important and deepest meaning of their focus groups results after
the election had about them the very familiar tone of psychoanalytic
argumentation. Some commentators said the recent Republican victory
was due to the war on terror, others said it was Bush's campaigning,
and some thought it was a fundamental shift towards conservatism,
yet others argued that the Democrats didn't get their message out.
The pollsters sounded very much like a group of therapists talking
about different possible causes of someone's problems. The search
for meaning, whether in politics or literature, or in the study of
an individual's life, leaves great uncertainty.
Reuben Fine (1983) and Janet Malcolm
(1981), among others, have pointed out the vast discrepancy between
the social effect of psychoanalytic thought and the rather restricted
range of it pursued in psychoanalytic academies. Psychoanalysis was
brilliantly extended to families, but then family therapists developed
nonpsychoanalytic models of family functioning and psychoanalytic
theorists left the field. When child and adolescent psychoanalysts
in APsaA wanted to become part of the APsaA, they were denied admission--because
psychoanalysis was for adults, not children. After the Second World
War, the mainstream APsaA establishment was appalled when Franz Alexander
posited that psychoanalysis works by providing analysands with a 'corrective
emotional experience.' Mainstream Freudian psychoanalysis retreated
to the position that psychoanalysis was involved with interpretation
only, and, strange as it may sound to the modern ear, psychoanalysts
of that era strongly rejected the idea that a corrective emotional
experience was analytic. Its paradoxical: Psychoanalytic thought spread
even as psychoanalysts focused on an increasingly narrow aspect of
the total vision.
So, that is my definition of psychoanalysis:
A psychoeducational discipline that provides intensive psychoeducational
experiences, aspires to be a science, functions as an ideology, and
has had a great influence on modern world. We turn next to the issue
of how psychoanalysis works.
How Does Psychoanalysis Work?
In science, the first step is to discover a reliable, replicable phenomena
and the second step is to explain it. For example, heredity is a reliable
phenomenon and its mechanism is the unzipping of the DNA genome and
its copying. For the field of psychoanalysis, the efficacy of the
psychoanalytic treatment should be the reliable, replicable phenomenon
that requires an explanation (i.e., a mechanism) for how it works.
For psychoanalysis, or any other therapy, the questions are, Does
it work?, and if so, by what mechanism? I want to take these questions
Does psychoanalysis work? There is no
research in psychoanalysis that has used experimental and control
groups, or randomized clinical trials, to determine whether psychoanalysis
in effective. The efficacy of psychoanalysis as a treatment, either
in comparison with no-treatment controls or with other treatments,
is therefore unknown. Fortunately, there is a type of study that bears
on the question. This research is based on retrospective reports,
which ask former therapands or analysands to rate their earlier treatments.
This type of research does not rise to the level of experimental v.
control groups, but it does provide suggestive evidence. A number
of such studies have been done, including one by Consumer Reports
which polled its membership. All of these studies have found that
longer therapies are rated more positively, and this strongly supports
psychoanalysis as a treatment, since most long treatments are probably
psychoanalytic. All of these studies also found that longer treatments
were more effective irrespective of the type of treatment undergone.
Thus there were no differences between Freudians or Culturalists,
or between psychoanalysts and cognitive behaviorists. Longer therapies
are more effective, no matter the theoretical orientation of the treaters.
The comparison of this finding to educational
outcomes is quite strong. Those students who take music lessons for
longer periods would profit more from it no matter the teacher, and
those who stay in college longer become more educated, irrespective
of the rating of the school. What is the mechanism? If psychoanalysis
is effective, the next issue would be to explicate the mechanism of
change. In psychoanalysis, the mechanism is called the 'action' of
psychoanalysis, and there are frequent articles and papers featuring
the subject of 'therapeutic action.' The literature on therapeutic
action follows the usual style in psychoanalysis, in which a thinker
may arrive at an interesting insight and illustrate it by examples,
an insight that may become popular among clinicians. The thinker's
ideas are often illustrated by case examples, but not tested by research.
It is the reading of this rich clinical literature that constitutes
training in psychoanalysis, much of which is an ability, at least
in MPC, to approach clinical material via listening to the patient
and using a variety of approaches and theories.
It is of interest that, even though
the effectiveness of psychoanalysis vis-à-vis controls or other
treatments has never been empirically shown, there is a scientific
research literature on one postulated mechanism for the (hypothesized)
successful effectiveness of psychoanalysis. This research tested the
Freudian view of the mechanism of change in psychoanalysis. The research
was mostly planned in the 1950s and 1960s, executed in the 1960s and
1970, and reported in the 1980s and 1990s. Freudian psychoanalysts
from APsaA did the research, and their viewpoint was that psychoanalysis
was an intense experience at 4x and 5x frequencies that featured the
establishment of a transference relationship which is worked through
by interpretation. This was regarded as the analytic process. This
analytic process, featuring the development of a transference neurosis
(which stemmed from an unresolved Oedipal Complex), and its resolution
via interpretation, was hypothesized to be the mechanism of cure.
It was the action of psychoanalysis, the hypothesized mechanism that
made psychoanalysis work. The presence of an analytic process would
lead to cure; its absence to continuing neurosis.
It is to the credit of these researchers
that undertook this research. They dared to test their beliefs, and
they represent the only school of psychoanalysis that has done so.
They used standardized psychometric assessments of analysands and
therapands prior to the onset of treatment, and at subsequent stages
during and following treatment. These were prospective studies and
not retrospective reporting, and they used objective assessment instruments
developed by the psychoanalytic researchers, and these features bring
their research into the scientific arena. The major prediction was
that successful outcome would be correlated with the therapies that
operated by interpretations and resolutions of (oedipal) transferences.
There were four major research laboratories that produced six studies,
and Wallerstein (2001) who was the chief investigator on the Menninger
study, recently reviewed them. The Menninger study involved a comparison
of psychoanalysis and supportive psychotherapy with 42 hospitalized
patients. The other three laboratories involved urban outpatients
at psychoanalytic clinics in Boston and at two institutes in New York
City. The study at the Boston Institute clinic involved 130 patients
who were seen for an average of 675 treatment hours. The Columbia
Psychoanalytic Center study involved two studies of 1,348 and 237
cases, 40% of whom were in psychoanalysis and 60% in psychotherapy.
The New Your Psychoanalytic Institute studies involved a first sample
of 82 cases, 40 from a clinic and 42 from private practices, and a
second sample was comprised of 160 private practice cases.
After the treatments were completed, their effectiveness was measured
using objective tests, including such factors as ego-strength, maturity
of object relationships, and severity of psychopathology. A "blind"
team of psychoanalysts independently assessed whether an analytic
process involving transference and its resolution had occurred. The
results of these studies were in striking agreement. The major finding
of the largest study, at Columbia, with 1,348 and the 237 cases, was
that 60% of the successful cases did not develop an analytic process.
Q. What percent successful cases resolved their problems by working
through their transferences?
Q. What percent of successful cases resolved their problems without
an analytic process involving transference and its resolution?
In the language of the original study,
"a substantially greater proportion of analysands derive therapeutic
benefit than develop an analytic process" (cited in Wallerstein,
2001, p. 251). The results were virtually identical in the other studies.
Wallerstein, a past president of the IPA and APsaA, whose bona fides
should be beyond question, is at pains to write that the results of
the Menninger study indicate that "The changes reached in the
more supportive therapies seemed
to represent just as much structural
as the changes reached in the most
(2001, pp. 257-258.)." And, "It is clear that an overall
almost an overriding one-has been the repeated demonstration that
a substantial range of changes-in symptoms, in personality functioning
and in life-style-have been brought about via the more supportive
(2001, p. 258)." He even goes on to say
that psychoanalysis should no longer be considered a heroic-or last-ditch-treatment
technique for the desperately ill, but that supportive treatment should
Another study completed in Boston entailed
an intensive investigation of the treatments of 22 supervised analytic
cases at the Boston Psychoanalytic Clinic. They replicated the finding
that more patients achieved therapeutic benefits than developed transference
neuroses, but they hypothesized that the therapist-patient match might
effect the treatment. This hypothesis is of interest because 'the
match' is a contemporaneous effect. This hypothesis seems to state
that the analytic process is not a necessary result of the inescapable
repetition of an infantile process, but that it is very much affected
by the analyst, by the match. But this is the fate of all hypotheses
when they are tested. They always prove to be more complex than initially
thought. The Mount Zion group (Weiss & Sampson, 1986), which does
research on psychoanalysis and on psychoanalytic short-term psychotherapy,
has found that short-term psychotherapies are more successful when
the therapist meets the therapands expectations about what he or she
wants from the treatment, which supports the 'match' hypothesis.
The second major finding of these studies was that no one factor predicted
successful outcome. There simply was no successful prediction of treatment
outcome from the variety of standardized measures used in the initial
evaluations and compared to follow-up. This is an odd result, but
was found in every study. Either the experimenters used invalid tests,
or failed to identify real predictors, neither of which seems likely,
or else the interactions between the parties is powerful as to negate
the effect of predictor variables. That seems hard to believe, since
factors like ego strength, severity of psychopathology, or family
history should be robust predictors. Still, at the present time we
don't know who will effectively use an analysis. The concept of analyzability
is a thus a promise awaiting future developments, and these data support
the importance of a trial analysis.
Comment and Conclusion
In reference to the issue of the nature of fact in psychoanalysis,
the issue that the prestigious IJP fumbled so badly, I would like
to state that the research findings cited above are facts in psychoanalysis.
Clinical facts, exactly what that IJP issue was supposed to be about,
but wasn't. They are facts because they are public, because they used
standardized assessment methods and large samples, and because they
have been replicated at independent laboratories. In the everyday
world of clinical practice, all of the words, behavior, nonverbals,
affects, and communications of the analysand and the analyst are facts
of psychoanalysis, and that is so because description is part of science.
. And now, in closing, it is time to give
my theory about these facts. As an inveterate object relationist,
these findings are heartening. The six researches on psychoanalytic
action all found that supportive relationships were as effective,
and as long lasting, as transference relationships. For Freud, positive
results were either due to interpretations or suggestion, but today's
clinician has a much broader range of techniques, including in alphabetical
order, attunement, bearing witness, being with, containing, detoxifying
projections, holding, listening, permission giving, reverie, serving
as an attachment figure, and support. That retrospective ratings show
that the length of the treatment (but not the technique) leads to
greater results further supports the role of the relationship. These
findings are sympathetic to a relational approach, but not definitive.
And not rigorous enough. Because, from a scientific view, we want
to specify the mechanism of change. We have to know the mechanism.
What does seem to be definitive is that
the concept that psychoanalytic change requires the experience of
transference neuroses is inadequate. I have noticed that I rarely
get intense or prolonged transference reactions with individuals undergoing
divorce, or with those who have a powerful, wealthy, cold and sadistic
parent. For those individuals, their emotional investments are already
cathected, and the therapist functions as a witness or a floating
positive in the transference. This idea, that transference is not
all, and that all is not transference, is a striking one. If taken
seriously, this will lead to a rethinking of psychoanalytic theory
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