Modern Psychoanalysis

Modern Psychoanalysis is a treatment for relieving mental and emotional distress. Its simple technique heals through the talking interaction between patient and therapist. Join us to learn more or post your own thoughts.

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Saturday, March 08, 2008

Clinical Techniques: #3 - Interpretation

Clinical Techniques: #3 - Interpretation

It may be useful to begin looking at this topic by briefly contrasting the modern understanding of the uses of interpretation with the classical approach. According to Dr. Hyman Spotnitz (1985, p. 166):

“Primary reliance on interpretive procedures is a distinguishing characteristic of the classical method. ‘(t)he ideal analytic technique consists in the analyst’s doing nothing other than interpreting,”… (quoting Fenichel and others)…, and the goal of the analyst is to provide insight.”

Where do verbal interpretations fit in modern psychoanalysis? While our previous writings have underscored the importance of continual silent interpretation to a successful modern analysis; we have also alluded to the potentially ego-damaging effects of interpretation on many of our most vulnerable patients.

As the title of this article suggests, modern analysts do use spoken interpretation as a clinical technique; though the expectation is that they do so in a much more careful manner than previous generations of analysts.

When may verbal interpretation be used as a technique in modern psychoanalysis?

That answer depends on the analyst’s answer to another important question - Where is the patient at?

A rule of thumb that might be applied is that “(a)n intervention is of value only when it helps the patient move out of a pattern of resistant behavior that is being engaged in ‘right now.’” (Spotnitz, 1985, p. 252, emphasis original).

Thus, verbal interpretations may be used when the patient is ready for them, and when s/he will not be damaged by their use. In the “resistance to cooperation” stage, for instance:

“When the patient is really cooperative, he solicits communications that will help him verbalize spontaneously and uncover the immediate obstacles to this. Then it is desirable for the analysts to interpret and answer questions with a view to facilitating the patient’s understanding of the analytic process.” (Spotnitz, 1985, pp. 181-82).

Spoken interpretations may even help protect the patient’s ego at times. For example, one patient, deeply engaged in self-attacking behavior; and saying “My friends tell me I should just let it go. I don’t let things go. I just keep talking about the same things over and over, but nothing ever changes;” was told “Certain things may need to be talked about over and over.”

In this case, the patient’s immediate reaction showed the effectiveness of the intervention – the patient was reassured, less self-attacking, and thanked the therapist for understanding the patient’s need to talk about some things over and over.

Dr. Spotnitz, (1985, p. 276), says that in supervision of other therapists, he has sometimes given the following advice (regarding patients jumping up from the couch):

“… the analyst may make an interpretation pointing out the significance of his own behavior, such as ‘You jumped off the couch because I stirred up too much emotion.’ Such an interpretation tends to facilitate the verbalization of hostility by the patient.”

Spotnitz points out the goals of “maturational interpretations” as follows:

"Any type of intervention that helps the patient say whatever he really feels, thinks, and remembers without causing narcissistic injury (citing Lucas) is designated as a maturational communication…. At the other end of the continuum is the interpretation that is given when requested, and when it will help the patient articulate his own thoughts and feelings… The therapeutic intent underlying the maturational interpretation is to help the patient talk progressively…" (Spotnitz, 1985, p. 253, emphasis original).

The intellectual attractions of interpretation to classical psychoanalysts may have been the cause or result of a certain amount of hubris in the profession in the past. I do not mean to suggest that modern analysts are exempt from this; or that modern analysts might not “inadvertently” use verbal interpretations inappropriately.

A case that comes to mind is one where the patient previously related a long and painful life story to the therapist. Some time later the patient and the therapist had a “falling out.” The patient experienced painful feelings as coming from the therapist, but managed to verbalize those feelings, in spite of the fact that s/he and the therapist were not getting along with each other.

The therapist’s response was to say “Kind of like… (alluding to a previous incident in the patient’s life)". Rather than investigating, the therapist effectively ignored the painful feelings of the patient in this case, even while appearing to connect to them through the interpretation that was given.

What could have been happening? There are any number of possible explanations; the therapist may have been defending against the feelings, may have been thinking s/he would “help” the patient, may have been too self-absorbed to relate to the patient at that moment, etc…, etc… What seems most clear is that this therapist was missing something from the therapist’s own unconscious.

As we’ve discussed many times before, successful treatment most often depends on analysts being closely in touch with their own thoughts, feelings and impulses. This is why modern analytic training takes so long and requires so much of it’s psychoanalytic candidates.


References


Spotnitz, H. (1985). Modern Psychoanalysis of the Schizophrenic Patient: Theory of the Technique, Second Edition, NY, Human Sciences Press.



© 2008, James G. Fennessy, M.A., J.D.
Matawan, New Jersey 07747
E-mail: njanalyst@hotmail.com
http://modernpsychoanalysis.org

Modern Psychoanalysis, Psychoanalysis

7 comments:

kris said...

Wow, thanks for the post. It seems to have answered a number of my questions about the modern psychoanalytic process. Of course, in the beauty of the psychoanalytic tradition, it has also raised a number of new questions/thoughts.

kris said...

One thought is that your discription of the modern psychoanalytic approach makes it seem incredibly gentle and humane. Very respectful of the individual's vulnerabilities and individual needs. I personally compare it to my limited knowledge of two other approches.

First, my take on classical psychoanalysis seems to mirror yours, (i.e., that the intellectual interpretations as they are practiced can potentially be ego-damaging).

The other approach I have (quite limited) knowlege of, is based on the book "Between Therapist & Client: The New Relationship" by Michael Kahn. There are notable similarities between Modern Psychoanalysis and what he decribes. This includes: the focus on the present as the nexus of change and, the highly respectful approach to the patient's current state & needs.

Are the two approaches related and if so, how? Or is this more of a synchronicity where two totally different approaches, found similar truths? Kahn focuses on the work of Merton Gill, Kuhn & the humanists. I don't recall you citing any of these in your blogs.

Jim said...

I am somewhat familiar with Merton Gill's work, but haven't seen much by Michael Kahn. Are there more similarities that should be looked at?

kris said...

I think the other similarity that strikes me is the assertion that therapeutic movement is about what takes place in the 'right now'. For many years, my ideas about psychoanalysis were stuck back in turn of the century Vienna. Specifically, believing that insight about past intrapsychic conflicts was THE curative factor.

You can bet that I read everything on psychoanalysis that I could find and attempted to do a bang-up job of analyzing the be-jeebers out of myself. Sadly, I found that I was a most resistant and contrary patient as well as the most cold and unfeeling analyst I ever had the misfortune to meet! ;)

On a more serious note, the focus on the present seems to present a malleability that the past never will. No matter how many times I replay that scene about losing my favorite doll when I was 4, the feelings of loss persist and perhaps even grow in their symbolic power.

But when I allow myself to experience abandonment/loss in the hour... that's when its possible for the "curse" to be undone.

Jim said...

:)

kris said...

How does an analyst 'know' how to create an intervention (that helps the patient say what he/she really feels, thinks, and remembers) WITHOUT CAUSING NARCISSISIC INJURY?

I am sensitive to anything that smacks of a narcissistic attack. I am used to living on guard, waiting for and attempting to avoid the next threat.

Of course, this is what I have brought to the hour too. However, after countless hours of waiting and being on guard, I am finding very little use for the constant vigilence.

At the risk of sounding like a broken record; what's the magic?

Jim said...

Excellent question.

The analyst does not always 'know,' but the good analyst follows a few basic tenets which are designed to reduce the liklihood of NARCISSISIC INJURY.

First, most interventions in modern analysis are only used based on the patient's own contact function; i.e., those times when the patient is seeking the analyst's participation.

Second, it is more imortant for the patient to say whatever s/he wants, than for the patient to say what s/he "really" feels, thinks, and remembers.

Finally, most of the magic comes from the years of training modern analysts have in working with the emotions and from the analyst's own understanding of themselves.