Free Association and Resistance

Free Association and Resistance

Professor Freud (1913, p. 147) insisted that there was one “fundamental rule” the analyst needed to tell the patient “…at the very beginning:

‘Your talk with me must differ in one respect from ordinary conversation. Whereas usually you rightly try to keep the threads of your story together… here you must proceed differently… You will be tempted to say to yourself: ‘This or that has no connection here, or it is quite unimportant, or it is nonsensical, so it cannot be necessary to mention it.‘ Never give in to these objections… say whatever goes through your mind. Act as if you were sitting at the window of a railway train and describing… the changing views you see outside.’”

This fundamental rule of “saying everything” has since been referred to as “free association.” How do modern psychoanalysts implement this rule?

First, we can say that modern analysts accept that “(e)ven the analytic directive to talk must be viewed as resistance-provoking.” (Spotnitz, 1976b, p. 169).

Spotnitz (1976b, p. 159) commented that one of Freud’s first followers,

“Ferenczi had noted many devices used by patients to resist cure. He observed how difficult it was for the patient to follow the first rule of free flow of ideas until the close of the analysis, and that patients could not understand that free association did not demand complete thinking out of ideas, but complete utterance of what was actually thought.”

Dr. Spotnitz (1976a, p. 78) also recounts that attempting:

"… to overcome the resistance to free association by ‘making use of psychical compulsion’… got Freud into various difficulties. Although time-saving, his approach proved traumatizing to the patient, giving rise to feelings of disturbance, strangeness, withdrawal and the like which inhibited or even blocked communication.”

This classical approach to resistance undoubtedly also caused many patients to be labeled from the very beginning as “unanalyzable” or ‘not suitable for treatment.”

I think it could be said that most modern analysts recognize and respect the patient’s need for the “insulation” (or defenses) that result in resistances. They do not try to “smash through” the defenses and may even help reinforce some defenses until the patient is ready to give them up. This same respectful approach is taken with the question of free association.

Spotnitz (1976a, p. 141, emphasis added) indicates that cooperative behavior would be:

“…that the patient lie on the couch and talk. He is not instructed to free-associate. As the opening move in educating him to do so, he may be asked to tell his ‘ life story’ or simply to talk of his experiences; a severely disturbed individual may begin by recounting how he traveled to the office, what he ate for breakfast, and the like.”

In modern psychoanalysis, the patient’s job is to talk, while the analyst bears the responsibility of helping the patient do so.

In most cases, modern analysts rely on the contact function of the patient’s ego in deciding when and how to help in the patient’s attempts to satisfy this fundamental rule of “saying everything.” This approach helps to safeguard the patient’s developing ego from unwarranted intrusion by the analyst. (See e.g., Fennessy, 2008)

The modern psychoanalytic approach to resistance and free association has had the added benefit of expanding the number of people who may be helped by our methods to the point where “… (w)ith our increasing understanding of the psychological reversibility of the narcissistic disorders, the phrase ‘not suitable for treatment’ has been dropped from the vocabulary of the modern psychoanalyst.” (Spotnitz, 1976b, p. xi).

References

Fennessy, J. (2008). Narcissism and the Contact Function, in PRACTICE MATTERS, A Journal of Modern Psychoanalytic Treatment Technique (Vol. 2), Philadelphia, PSP.

Freud, S. (1913). Further Recommendations in the Technique of Psychoanalysis (On Beginning the Treatment) in Freud; Therapy and Technique, (Philip Rieff, Ed., 1978), NY, Macmillan Publishing Co., Inc.

Spotnitz, H. (1976a). Psychotherapy of Preoedipal Conditions, N.Y., Jason Aronson.

Spotnitz, H. and Meadow, P. (1976b). Treatment of the Narcissistic Neuroses, NY, Man. Center For Advanced Psychoanalytic Studies.



© 2006, James G. Fennessy, M.A., J.D.

Matawan, New Jersey 07747
E-mail: analyst@modernpsychoanalysis.org
http://modernpsychoanalysis.org/

Ambivalence

Ambivalence

"This is one race of people for whom psychoanalysis is of no use whatsoever" (Sigmund Freud - about the Irish)

There were various reactions expressed by others when the above quote first appeared in my printed list of Irish songs for St. Patrick’s Day – some were outraged, while others laughed their heads off.

Possibly either reaction is understandable, or perhaps one person could entertain both reactions at the same time. In fact, I’ve often thought that the ability to tolerate seemingly conflicting ideas at the same time was a peculiarly Irish phenomenon.

Professor Freud has also been quoted as saying that

“Neurosis is the inability to tolerate ambiguity.”

I don’t believe Freud was using “ambiguity” in a conventional American way, i.e., as a synonym for vagueness or uncertainty; but rather more in the sense of “the quality of having more than one meaning,” or “capable of being understood in more than one sense.” (New Lexicon, 1988).

That understanding of ambiguity is closer to how I mean to refer to ambivalence, i.e., as a state where one has disparate feelings (which may or may not be conflicting) at the same time.

In this respect, I am also proceeding from the belief that much of life, or of our human structure, involves ambivalence.

Observably, people may seem to be functioning adequately and yet be unaware of their ambivalence. Those feelings may instead be repressed, or subsumed in our unconscious processes; though this does not rob them of the capacity to affect our actions, thoughts, perceptions and emotional resiliency.

According to Daniel Siegel:

“Excessive rigidity in a state of mind leads to an inability to try new configurations and to adapt flexibly to changes in the environment.… Homeostasis is achieved at the expense of the connections with others and with primary emotional states of the self.” (1999, p. 237).

Modern analysts recognize this inflexible pattern as part of the structure resulting from the Narcissistic Defense, i.e., a question of what the child has learned to do with aggressive (or other “unacceptable”) impulses mobilized in his mental apparatus. Modern Psychoanalytic treatment seeks to restore human flexibility and emotional resiliency through its clinical methods.

In this sense it might even be said that recognition and acceptance of ambivalence is a good thing; or as Publius Terentius said, "I am a man: I hold that nothing human is alien to me."

References

New Lexicon Ed. (1988). New Lexicon Webster’s Dictionary of the English Language, NY, Lexicon Publications.

Publius Terentius Afer. (185 BC - 159 BC). (Terence). Roman Comic Dramatist.

Siegel, D. (1999). The Developing Mind, NY, Guilford Press.

© 2006, James G. Fennessy, M.A., J.D.
Matawan, New Jersey 07747
E-mail: njanalyst@hotmail.com
http://modernpsychoanalysis.org/

Modern Psychoanalytic Education

Modern Psychoanalytic Education

Psychoanalytic education in the United States is still mainly conducted in free-standing Institutes, rather than in University settings. Typically, certifications are awarded, rather than academic degrees, though training in Institutes is often years longer than that taken for academic degrees.

Education in Modern Psychoanalytic Institutes usually consists of around 24 courses, weekly individual analysis, supervision, clinical experience, giving and attending case presentations, and presentation of a final case. It would not be unusual to spend 7-8 years working towards certification.

Students in many Modern Psychoanalytic Institutes are permitted to proceed more or less at their own pace. Some Institutes also permit the general public to take courses in psychoanalysis for personal enrichment.

Modern Psychoanalytic Institutes do not require that their candidates be medical doctors. This follows Professor Freud’s thoughts on the subject (1926):

“No one should practice analysis who has not acquired the right to do so by a particular training. Whether such a person is a doctor or not seems to me immaterial.”

On the other hand, most Institutes require at least a Masters Degree for eventual certification. Freud’s statement (1926) would still be true, that:

“Lay analysts, as they are found practicing today, are not chance-comers, recruited and trained without discrimination, but persons of academic standing.”

What should Modern Psychoanalytic Education consist of? Perhaps part of the answer to this question lies in looking at the work modern analysts are being trained for.

According to Spotnitz (1997, p. 36 & 38):

“Most of the work in the analysis consists in asking question after question, following the patient’s unconscious as closely as a shadow in the exploration that will lead to the uncovering of layer after layer, until the point is reached when the patient discovers a truth about himself through his own voice.” And “The fact remains that analysts need to know their own unconscious as much as that of their patients…”

Individual analysis and supervision would, therefore, seem to be indispensable to a Modern Psychoanalytic education. The undersigned writer also highly recommends that all Modern Psychoanalytic Institutes follow the lead given by one of the Institutes – i.e., include Transference & Resistance Workshops in each semester’s curriculum.

Freud (1914) incorporated Transference & Resistance into the very definition of the question; “What is Psychoanalysis?:

“… the facts of transference and resistance. Any line of investigation which recognizes these two facts and takes them as the starting point of its work may call itself psychoanalysis, though it arrives at results other than my own.”

Transference & Resistance Workshops explore these concepts through group discussion in an experiential setting. The experience with using Transference & Resistance Workshops has been greater expression and understanding of feelings by students and less acting out. Having experienced these Workshops myself, it has been difficult for me to imagine Modern Psychoanalytic education without them.

References

 
Freud, S. 1914. The History of the Psychoanalytic Movement; (fr. Freud, S. (1938). Basic Writings of Sigmund Freud, (Modern Library Edition, 1995; trans. Dr. A.A. Brill), NY, The Modern Library).
 
Freud, S. 1926. The Question of Lay Analysis; (fr. Freud, S. (1938). Basic Writings of Sigmund Freud, (Modern Library Edition, 1995; trans. Dr. A.A. Brill), NY, The Modern Library).

Spotnitz, H. (1997). The Goals of Modern Psychoanalysis: The Therapeutic Resolution of Verbal and Preverbal Resistances for Patient and Analyst (CMPS/Modern Psychoanalysis, Vol. 22, No. 1, 1997)

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

© 2006, James G. Fennessy, M.A., J.D.
Matawan, New Jersey 07747
E-mail: analyst@modernpsychoanalysis.org
http://modernpsychoanalysis.org/

Long-Term Treatment in Modern Psychoanalysis

Long-Term Treatment in Modern Psychoanalysis

Psychoanalysis is often criticized for taking too long, and for being far too costly when the money paid over all those years in treatment is added up. This brief writing contains just a few thoughts on the uses and resistances involved in thinking about long-term treatment.

The average time of those staying in psychoanalytic treatment in the United States is estimated to be somewhere over 5 years. Yet, when our patients first come to see us, it is unlikely that many plan on staying in treatment for over 5 years; let alone for the 10 or 20 years that some do.

As Dr. Hyman Spotnitz notes: (1985, pp. 112-13)

When contemplating treatment… pathologically narcissistic individuals are rarely interested in change. What they want primarily – and immediately – is relief from emotional suffering. They are more likely to feel that they would be investing time, money, and effort just to prove they are incurable.

So, how long is too long to be in analysis – how much time and money should one spend addressing life-long difficulties? Perhaps our views about therapy before we enter it would help with the answer.

Arnold Bernstein (1995, p. 52) contends that:

The expectations of both the therapist and the patient are derived from their preconceptions of what psychotherapy is, and of what it means to be cured. Foremost among these preconceptions is that the patient is ’sick’ and that the treatment is to be regarded as medical in nature.

Prior to entering treatment, patients can entertain a variety of other ideas about what treatment means and what might happen during the treatment. (See e.g., Strean, 1985, pp. 110-112).

Modern psychoanalysts generally try to create an analytic space or “holding environment” where it is safe for the patient to “say everything.” In this context, resistance most often refers to whatever interferes with saying everything (talking) and the modern analyst works at whatever level the patient is at.

Thus, a patient with difficulties which may have developed in the pre-verbal (or pre-oedipal) stage of maturation might be helped to develop a narcissistic transference before moving further.

According to Spotnitz, (1985, p. 121), in most cases 2 years would be “… the minimum duration for significant change to occur” and “(a)lthough the effective reversal of the schizophrenic reaction requires a minimum period of 5 years, the treatment may continue for a longer period.”

Freud (1913, p. 130) similarly stated “(t)o shorten analytic treatment is a justifiable wish… unfortunately, it is opposed by a very important factor… the slowness with which deep-going changes in the mind are accomplished.” We can certainly see the point where serious difficulties, such as schizophrenia, are concerned.

However, our minds often reject the idea of creating such intense long-term emotional attachments to strangers.

As Bernstein (1995, p. 51) says:

A prolonged therapeutic relationship is more likely to be a source of embarrassment… than a cause for rejoicing. Quite the contrary is the case when other personal human relationships come to an end. When marriages, families, friendships and loveships break up, it is generally conceded that something went wrong.

So it may horrify one, looking at it from the outside - to hear of an individual spending many thousands of dollars over 5, 10 or 20 years in analysis - but, if it helps that individual achieve a real and meaningful life, was it all worth it? Only that person can say.

In the end, perhaps its all a question of value and connection. How do we view our attachments, ourselves, and our value as human beings? What are those things worth?

References

Bernstein, A. (1995). Some Clinical Observations Upon the Emergence of the ‘Wonder Child” (CMPS/Modern Psychoanalysis, Vol. XX, No. 1, 1995).

Freud, S. (1913). On Beginning the Treatment. Standard Edition. London, Hogarth Press, 12:121-144.

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

Strean, H. (1985). Resolving Resistances in Psychotherapy, NY, Wiley.

© 2006, James G. Fennessy, M.A., J.D.
Matawan, New Jersey 07747
E-mail:njanalyst@hotmail.com

About Modern Psychoanalysis

The Talking Cure

Psychoanalytic Therapy is a treatment for relieving mental and emotional distress. It is often known as THE TALKING CURE because its simple technique heals through the talking interaction between patient and therapist.



Modern Psychoanalytic Services are therapeutic services based on an understanding of the unconscious and how unconscious processes affect the human mind as a whole, including actions, thoughts, perceptions and emotions. The major function of the psychoanalytic therapist is to listen carefully and attentively to the patient in order to understand and facilitate communication. When a patient can get in touch with and express all of his or her feelings, good and bad, emotional healing can take place.



This form of treatment for mental and emotional troubles was first developed by Sigmund Freud in early part of the last century. Later psychoanalysts expanded on Freud’s work and enlarged the range of problems that could be treated. New treatment techniques and insights into human behavior have also developed.



The science of Modern Psychoanalysis has demonstrated its ability to successfully deal with mental and emotional difficulties through its studies of early parent-child interactions, frustration, social relations, family dynamics and psychosomatics.


Modern Psychoanalysis


Modern Psychoanalysis, as expressed by its founder, Dr. Hyman Spotnitz, has gone beyond Freud, and addresses modern needs, since it “...has been reformulated on the basis of subsequent psychoanalytic investigation.”


Modern Psychoanalysis utilizes a wide range of interventions including ego reinforcement, emotional communication and resistance resolution.

The modern theory of treatment considers most emotional, mental and personal achievement problems to be reversible through our techniques.


The modern analytic therapist does not usually give lectures or advice about how the patient ought to manage his or her life. Instead, the analyst prefers to help the patient understand why he or she is unable to solve problems and internal conflicts that might be preventing one from knowing what to do in life.


Our goal is to help people improve the quality of their lives and their relationships.


James G. Fennessy, M.A., J.D.
Matawan, New Jersey
Email: njanalyst@hotmail.com