Modern Psychoanalysis

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Saturday, July 26, 2008

Some Miscellaneous Thoughts on the Clinical Practice of Modern Psychoanalysis

Some Miscellaneous Thoughts on the Clinical Practice of Modern Psychoanalysis

These thoughts and questions are primarily directed to modern therapists. In this context I’m assuming that modern analysts are already aware that they have their own “blind spots” and defense mechanisms - first, as people; and, second, as analysts, to protect them from “dangers” of the analytic situation.

The Omnipotent Analyst

While the curative mechanism we use is talking, language also uses and intensifies our feelings of omnipotent control. In reality language is simply an overlay on top of the organizing functions of our brain which are emotional/implicit/non-semantic memories, more primitive and present from birth. (See e.g., Fennessy, 2006).

In this respect, analysts in training sometimes succumb to the temptations of finding new outlets for their own narcissism through a mechanism that looks something like the following:

“Aha, now I am fully aware of what the pattern is… I am getting so aware (so much better)… (and then) …. Now I am much better and much more aware of everything….”
In other words, the narcissism of the analytic student does not disappear, but simply changes it's manifestation – creating in some cases omnipotent analysts who merely portray self-aware analysts. It’s a type of play-acting that many of us are all too familiar with.

This becomes a challenge for both analysts and patients when therapeutic sessions contain lots of primitive material on both sides, or when the analyst must face the challenge of feelings aroused in the statement “I’m doing nothing.”

The ultimate problem for the therapist is encapsulated in a recent comment by an esteemed mentor of mine: “It’s the resistance that burns you out, not the feelings.”

Analysts with these challenges may tend to avoid numerous feelings, including positive feelings such as love and compassion, as well as negative feelings. Using Winnicott’s term, over a period of time the “continuity of being” of the analyst may even be severely threatened.

While some of us may be under the impression that everything revolves around us, therapists don’t usually have less of the narcissistic instinct than others do, though it makes a bigger difference to us and to our patients than some realize.

We might ask, why have we chosen a “helping” profession in the first place? I think this is an important question for each of us to answer.

Some analysts maintain an attitude of helping, or wanting to help, as their main source of satisfaction or fulfillment for doing the therapeutic work. This is not necessarily an impediment to good work. Insofar as this attitude represents a feeling, or set of feelings, it should be experienced and worked through; and there may be situations where the analyst can use the feeling.

However, in a clinical sense it is important, for the patient and the analyst; that all of the narcissistic components be worked through; because of the analyst’s need to separate their impulses from what might need to happen in the room to actually help the patient.

The Importance of Emotional Education

The education of modern analysts through Transference and Resistance Workshops in each school term (previously mentioned in this forum) provides the necessary environment for training many modern therapists in working out these important issues.

The long term group environment of the “T&R Workshops” help students examine and work through their own emotions and tendencies at the same time as they observe and interact with the emotions and tendencies of other members of the group.

Students learn to experience the delicate balance of feelings that we all have throughout life. In this context, we may find that our own narcissism becomes increasing annoying to us over the years; we may also learn that many of us overevaluate our relationships in the workshop, or the other members of the group; or that our own narcissistically-based activities may carry a degree of risk (of narcissistic injury) to us due to the overvaluation of objects.

We may also learn that it’s better to go with the feelings; rather than try to force the balance and that there’s a limitation to most attitudes when we try to consciously impose them on ourselves, rather than let them develop naturally. Or, we may be aware of that constant tug-of-war between living in one’s own head and living in the world.

The workshops, when later combined with the powerful effects of our own analyses, individual and groups supervision, and case presentations, help modern analysts become far more effective with their own impulses and with others.

As with our patients, the repetition of certain statements or certain important things over a period of time helps with the learning process and our development of different perspectives. It’s a life-long process for most of us.

Talking

While we need to learn to work with our feelings, we also need to keep in mind that for many patients it’s not the similitude of feelings, but the similitude of words that makes a difference in modern analysis. This is not to infer that therapy doesn’t need to be something of a genuine relationship, at least in the sense that genuine emotions are involved. But, we must also understand that successful modern therapy depends on staying with the patient, not taking the patient where we want them to be.

We do not understand everything. Other things we know something of, but many of those are still imperfectly understood – such as whether and how might protective impulses overlap with aggressive impulses. How often do we seek to “protect” our patients – intervening as well-meaning parents may have in the past to cut off their free associations?

A little goes a long way. Many of us tend to think that our words need to “make an impression” on others. A natural human tendency is to use an abundance of words where less will do, or to repeat ourselves, or to overemphasize our points. In my experience, patients are much more sensitive to our words than we normally realize.

Opposing our native tendencies, it could be said that words tend to have more value when we use them less often (though hopefully measuring those words we do use). The fact that an intervention or clinical technique of some kind may be warranted in a particular case should not cause the therapist to leap ahead in an unrestrained manner. Are we simply suppressing our own narcissism for a time, waiting for the opportunity to display our brilliance?

While thinking of my patients, I’m sometimes reminded of an interaction I observed a while ago:

I was sitting in a waiting room when a mother came in with her young daughter; the child was about 2 years old. There was a big bucket of toys in the waiting room and some children’s books. The young girl was quite active; crawling around on the floor; grabbing toys, offering some toys to the mother and quickly moving on to the next toy. For quite some time the mother pursued the child; constantly trying to interest her daughter in a book the mother held, but to no avail. As it became increasingly important to the mother to interest the child in the book; the child remained active, but undeterred from her own tasks. At one point the mother looked at me in frustration and apologetically stated, “She doesn’t read.” I remember having strong feelings of wanting to say something to the mother, but also thinking it would be too intrusive to do so. It was most saddening to me that the mother ignored the child’s attempts at communication (with the proffered toys) as much as the child ignored the mother’s crazy attempts to force her 2 year old to read.
To help our patients we need to learn to pay attention to their efforts to communicate and recall how difficult that may be for some. Sticking closely as possible to the patient’s own words, and staying with the patient where s/he is, are most important.

According to my same mentor “patients have lives outside of their sessions with us.” We might also like to keep in mind that the successive frustrations inherent in personality growth make the ordinary living of life an exceedingly difficult task for extremely disturbed persons; their entire lives may be exercises in frustration and/or anxiety.

Just as mental/emotional difficulties are usually multi-determined and over-determined, so therapists and patients alike frequently have more than one reason for what they say or do. So often in observing individuals with difficulties we might say “They must be doing this on purpose.” To an outside observer it may look that way, or it may look like acting or melodrama; while the internal experience of the patient could be quite different.

While our words may be the same, meanings remain individual to each one of us. What makes what happens in the session real? How do we bring the reality of the patient’s life/patient’s emotions into the room? You don’t disclose everything – why should your patients? I suppose it doesn’t hurt to have as many explanations as possible available to us when we are feeling perplexed by some of our patients.

Yet, our theories and ideas can also get in the way of good treatment. So we say that to the extent that a particular view, or model, or idea helps us with a particular patient in a clinical setting it should be maintained and to the extent that it does not help us, it should be discarded or filed away for future clinical use.

And every interruption interrupts the patient’s free association. Additionally, anything the analyst says creates a counterpressure in the patient; (e.g., one may actually increase the amount of action by specifying it’s prohibition).

The frustration engendered by the analyst intervening at the patient’s point of defensive operations can also work as a re-creation of that primary frustration that started things along the continuum. If so, the analyst walks a fine line, keeping that frustration within certain limits; protecting the patient and allowing the growth process to develop further.

Of course, that’s the point. Clinically, the only value of transference is that it can develop into resistance and be resolved. Don’t foreclose opportunities for transference - whenever you speak, you do! (e.g., “Of course, we could never have sex;)” (unless your patient is psychotic).

What is the importance of the analyst as a suitable “object” for the patient? - i.e., it would do less good for a patient to lie on a couch in an empty room and talk to the walls - there is an intrinsic importance to talking to an acceptable “other.”

The acceptance of all of our feelings

Our society sometimes mirrors that “mind-body split” that takes place as part of our maturation.

I’m reminded of someone I know who has all kinds of unusual physical things going on, but he’s seen a number of doctors and had countless tests in the past few years, and they can’t seem to find much wrong with him. His wife recently commented that he was at the end of his rope and “willing to try anything.” I asked if he’d be willing to talk with someone and was quickly told, “Oh, he would never do that!”
While not usually desired in life, it can be useful for us to be aware of all of our negative (as well as positive) feelings in the countertransference. For example, even a negative feeling such as hate may be useful in the countertransference because I think 1). It is often overlooked, by analysts, patients, parents; 2). It may be found side-by-side with other undesired feelings; and 3). Known or unknown, it is (or was) a part of many relationships.

There’s usually another side of the coin when it comes to feelings; i.e., sex/aggression, frustration/love, etc.., etc… One of the many benefits of a bit of experience is that after a time modern therapists sometimes develop a type of “inner voice” with respect to their range of feelings and interventions.

Asked to describe the process: “How did you know that was the right intervention at the right time?”

The experienced therapist may answer: “I’m not sure;” and only later be able to articulate a specific reason.

Acceptance of all of our feelings results in benefits for modern therapists as well as for their patients.



References

Fennessy, J. (2006). The Mind in Modern Psychoanalysis, online at http://modernpsychoanalysis.org/Documents/MindMod_PsyA.pdf


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


Modern Psychoanalysis, Psychoanalysis

13 comments:

kris said...

Ahhh...the question of whether one should lead or pursue in the analytic setting.

I found two things pretty instructive and useful in trying to come to an understanding of this:

The example you gave of the mother and her two-year-old daughter who was not interested in reading, and the quote you have used elsewhere from Siegel (1999) about right hemisphere to right hemisphere resonnance (quoted in "The Mind in Modern Psychoanalysis").

In the scenario of the mother, I saw how the attempt to LEAD (her child to read) resulted in an unsuccessful PURSUIT. The impact of this interaction seemed clearly to be unsatisfying to the witness as it must have been to both mother & child.

So what is one to do? Being the veteran mother of two young sons has shown me that attempts to "bend their will" is an exercise in futility and mutual frustration. What has been much more useful is to at all times, be as (exquisitely) attuned to their needs as well as to anticipate their needs and to respond in the most gentle manner possible based on real life constraints.

It is this (hopefully exquisite) attunement or "right hemisphere to right hemisphere" resonnance that is the basis of real communication. Why the Modern focus on "saying everything?"? Precisely because the left or 'verbal' hemisphere is the most useful pathway to this resonnance.

But then the question arises, what to do with this resonnance once it is attained. Would this the right time to begin to lead? This is a more difficult question.

I believe, that ressonance is a massively satisfying state that humans get far too little of (at least that's my personal experience). I think that once this level of connection is established between two people, that (even though is cannot be continually maintained at a high level), the dyad will continue to seek return to the state. This is where the analytical leverage is created and at times incorrectly or inadequately used.


Resonnance is perhaps at its center, a lowering of defenses. This is a dangerous and risky state to be in. This would be true for both patient AND analyst. The ability to seek and attain a true and high level of connection indicates that the analyst is also less defended than in everyday settings.

In order for this to be a growth experience (for the patient as well as the analyst), it demands that the analyst has made good use of all the training methods that elucidate and "tame" his or her own primitive defenses, needs, etc., so that when this connection can or does happen, that the analyst can utilize it without being overrun by the narcissisitic issues so many of us battle.

Hugo said...

Have you ever read the series of panels (1053-1956) the American held to discuss the issues of technique (orthodox vs modified) and where Alexander attempted to publicly defend his position? Some person named Weigert, for example, speaks of "demand feeding" in terms of technique and the spacing of sessions. Do you know if Spotnitz was influenced by these debates at all?

Jim said...

I haven't read that series of panels. Do you think Spotnitz might have been influenced by these debates?

Hugo said...

Hard to tell...The 50's were abuzz with the same ideas Spotnitz presented in his work, and everybody was reacting to Alexander's proposal to make psychoanalysis flexible (Spotnitz does mention him). However, Spotnitz was the only one to systematize such ideas into an analytic program that was cohesive enough to be called a "new school". there was no internet at the time, but those debates were quite significant as an example of IPA trying to rein in spurious ideas and to put them down as wild psychoanalysis, psychotherapy, etc. They are a good read, the debates.

hugo said...

Jim, if you ever get a chance, check the panels I mentioned and also this article by Bibring:

(1954). Psychoanalysis and the Dynamic Psychotherapies. Journal of the American Psychoanalytic Association 2: 745-770
Edward Bibring, M.D.

It was the IPA attempt at differentiating between psychoanalysis and psychotherapy. I'll be interested to hear your thoughts and if you happened to find any references on how Spotnitz dealt with the APaA's debates, pls share.

Therapy said...

this has been a very interesting article!! I think most people like the academic nature of science and medical research. People are willing to experiment with new drugs but not psychotherapy.

Julie said...

Hi Jim,
Just came accross this the example of the mother and the child reminds me of the Strange Situation and the subsequent assessmest of the child's emotional security.Our counselling room is indeed a Strange Situation to a client, where we are in turn assessing a client's emotional world.If only that mother cherished the impact of her own presence on her child's emotional world, it would perhaps make her think twice about her need to intellectualise him.

Tony said...

This might interest readers of this blog: psychoanalytic author Robert Rowland Smith's new book comes out later year. Check out www.robertrowlandsmith.com for more info.
Robert writes non-fiction that applies philosophy, psychoanalysis and literature to the concerns of everyday life. His book Breakfast with Socrates: the Philosophy of Everyday Life is published this year by Profile.

Sheila said...

Hi Jim,
Hi Jim, Sheila(or Julie) here from Eire,I want to thank you for linking to my web page. I have also linked my site to your blog.

I am just curious how did you come accross my web site?Also have you stopped blogging as I haven't seen anything from you for a while, maybe I am not looking in the right place.I hope you keep up the great work!

All the best,
Sheila Hayes

Jim said...

Hi Sheila(or Julie),

I think there was a post w/ your link, but perhaps we couldn't verify the post, but linked to the site.You're looking in the right place, I do plan to post more in the future, though can't say exactly when just now. Thanks for the kind words.

All the best,
Jim

UnmotheredChild said...

Oh I am loving yourblog and will put it on my blog list. I am a therapist in training. My goal is to become a psychoanalyst one day.

"It’s the resistance that burns you out, not the feelings."

Interesting statement...

Melbourne Psychotherapist said...

I am so glad I found your blog. I will link to it, and return again and again. I have a psychotherapy practice, and blog. I wondered what are your views on Lacanian Psychoanalysis in particular?

Jim said...

Thanks for the kind words. I am curious about Lacanian Psychoanalysis and wonder if there is anything about it on your blog?