Mechanisms of Cure
Practical Use of Modern Psychoanalytic Clinical Techniques
Within our overall mission of helping to cure what ails someone; our thoughts, and subsequent clinical applications of technique in therapy sessions may be viewed from a variety of perspectives. Following our initial contact, are all our innumerable questions regarding the etiology of the patient’s ailments, how to view the case, how to view what is going on in the session, and what to do, or not do, etc… in response to the patient’s contacts with us.
This writer’s opinion is that the practical matters of treatment deserve the most attention. The concern is that we are using clinical techniques that are appropriate to the circumstances, i.e., that work! Clinical techniques have little or no value if we are simply following a formula without appreciable improvement in the lot of our patients. However, I’d like to speak here for a bit about some general guidelines for the analyst’s talking.
In particular, what functions are served by psychosis and how should we treat psychotic material during therapy sessions?
Functions of Psychosis
People are complicated… thus, while the origins of psychosis are likely multidetermined in a particular individual, psychotic operations may be recognized by their biological and psychological results. Dr. Hyman Spotnitz notes that “An excessive tie-up of neurons in fixed and pathological patterns and overactivity or underactivity of certain neuronal systems are generally associated with mental illness.” (1985, p. 96, emphasis original). Psychologically, the psychotic operation functions partly as a defense; Dr. Spotnitz says that in
…view of the tendency of the schizophrenic patient to take flight, mentally or physically, from a frustrating object, his capacity to engage voluntarily, for therapeutic purposes, in a psychologically retrograde process is assumed to be extremely limited…the move backward in memory may give rise to severe defensive regression and tempt him into the ultimate refuge of psychosis. (1985, p. 170, citing Rothstein, A., 1982).
Modern psychoanalysts, such as this writer, are usually interested in providing a setting where patients are able to engage in progressive verbal communications, otherwise known as “maturational communications.” While all of the patient’s communications are silently, and continuously analyzed, little or no interest may be shown by the analyst towards patient’s psychotic material. This approach avoids forcing our patients into regression.
The question arises, what about the value of insight or understanding as a clinical tool? Dr. Spotnitz provides a concise answer in the following dialogue with one of his patients (1985, p.260), from a section entitled:
The Key to Analytic Cure
A: Suppose you convince me that you are as inadequate as you say you are, where does that lead us?
[P: That will help you treat me.]
A: How will it help me?
[P: Then you will understand me.]
A: How will my understanding help you?
[P: It will help me get well.]
A: Understanding alone doesn’t help anyone get well. I have demonstrated understanding and you are not getting better.
[P: Then how am I going to be cured?]
A: What cures you is dealing successfully with whatever interferes with your talking out your feelings, thoughts, and memories as they occur to you here.
How Much Talking by the Analyst?
Obviously, the answer to this question is that it depends on the circumstances! The analyst needs to insure that the patient’s frustration levels during the session are in a tolerable range. Let’s says that an exceedingly small amount of frustration may be helpful to our patients, but larger amounts are normally counterproductive. Action potential is a related concern. In this writer’s estimation, many, if not most individuals, are more susceptible to taking action, rather than talking, where intense human emotions are involved. Our natural “preference” for action (whether conscious or unconscious) is somewhat remedied by the analyst’s abilities to resolve resistances to maturation communications. Dr. Hyman Spotnitz says:
The analyst’s participation in resolving resistance is consistently one of providing communications that will enable the patient to verbalize freely all impulses, feelings, thoughts, and memories. In the course of progressive language discharge, the interneuronic structures whose repetitive activation… has served to block maturation are gradually redirected. (1985, p.104).
Too much talking, or too little talking, by the analyst (possibly mirroring the patient’s parents), each have the potential of proving damaging to the patient. The amount of talking needed from the analyst is expressed by Dr. Spotnitz in terms of “units of communication,” and Spotnitz says that even as little as “…2 to 5 units of communication with gradual expansion in this range…” may be appropriate for patients requiring resolution of certain resistances (1985, p.110).
Patients may be greatly frustrated and distressed when they first arrive at psychotherapy. Modern psychoanalysts are particularly well-trained to work with patients as they present, and to help these patients fulfill their desires for personality maturation.
Spotnitz, H. (1985). Modern Psychoanalysis of the Schizophrenic Patient: Theory of the Technique, Second Edition, New York, Human Sciences Press.
© 2016, James G. Fennessy, M.A., M.S.W., J.D.
Matawan, New Jersey 07747