Illusions and Disillusions of Psychoanalytic Work

Andre Green, Andrew Weller

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9781855753297
• eBook ISBN:
  9780429914744
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Illusions and Disillusions of Psychoanalytic Work recounts and explores the disappointing and sometimes tragic evolutions of the treatments of certain patients who are resistant to the effects of analytic work. In this book the author reports cases taken from his own experience and that of his collaborators. The author points out moreover, that such cases have never been absent from the series of analysands that he has treated, from the early days of his practice up until today, without minimizing his counter-transference reactions or their possible impact on these disappointing evolutions.

Part I
Theoretical Study

Chapter One
From the treatment of neuroses to the crisis of psychoanalysis

During the last years of his life and up until his death, Freud was constantly asking himself questions about the obstacles standing in the way of psychoanalytic therapy. This was the reason he wrote “Analysis terminable and interminable” (1937c). He returned to the question shortly after, in 1938, in An Outline of Psychoanalysis (1940a [1938]). There he notes the causes for the lack of success of psychoanalysis without giving any definitive answers, but emphasizes the effect of the destructive drives. He affirms his interest in forms of regression akin to psychosis, but not as serious as the latter. In other words, he was already wondering about what would subsequently be called borderline cases, and he seems to have foreseen the evolution that would make them a major theme of interest in the future.

In 1999, the Newsletter of the International Psychoanalytic Association published the results of a vast survey on psychoanalysis and related therapies. This survey masked a certain degree of concern about what appeared to be a loss of ground by psychoanalysis, accompanied by a corresponding progression of the psychotherapies. Admittedly, the various psychoanalytic movements do not always give concordant results. In North America, psychoanalysis and the psychotherapies are no longer separated by a sharp dividing line. The only difference is in the number of weekly sessions. The survey revealed many disillusions concerning the method and the rules that had governed the practices of earlier generations.

In Northern Europe, “psychoanalytically trained” psychotherapists are exerting pressure to have their activity better recognized. Elsewhere, in certain countries where there is a policy of reimbursing sessions fully, irrespective of the number of weekly sessions, few patients are ready to undertake an analysis of four or five sessions a week. By way of a curious exception, the British Psychoanalytical Society did not respond to the survey. But it subsequently published interesting results concerning practice in the UK. Sixty per cent of cases were reckoned to be in analysis. Concerning the remaining 40%, the information is not very precise regarding the setting of the therapies proposed to the patients. Yet it may be estimated that 30% at least of the patients treated by psychoanalysts in the UK are proposed psychotherapies. This significant figure gives no precise idea of the modalities or principles of the psychotherapies practised. There is every reason to be astonished by the scarcity of information published under this rubric concerning what amounts to a considerable proportion of cases, and by the scarcity of observations concerning psychotherapeutic practice.

However, elsewhere in Europe, and especially in France, the difference between the classical treatment and the face-to-face treatment is still maintained, even if, in certain cases, psychodrama is recommended alongside the psychotherapies (particularly in France).

This leaves South America. The survey notes a high proportion of psychotherapists who seem to suffer from problems of identity compared with psychoanalysts. This situation is the result of the choice made by many psychoanalytic societies, which, following the example of the American Psychoanalytical Society, have long considered psychoanalytic practice as the exclusive reserve of doctors. This has not prevented the prominent analysts of these societies from participating in the training of psychotherapists in those institutions that sought their expertise. Over the course of time, psychotherapists have pointed to the quality of the training received from prominent practitioners of psychoanalysis in order to demand recognition for their field of competence. The change of policy in psychoanalytic societies, many of which have made psychoanalytic training available to candidates without medical training (following the English and French societies), has already modified the situation.

Finally, current generations are affected by a mutation related to the historical and socio-economic changes affecting psychoanalytic activity:

• the increase in the number of analysands presenting narcissistic and identity-related pathologies, borderline states, etc.;
• the variation of indications, which shows that more and more neuroses are treated face-to-face, with fewer weekly sessions.

These observations raise questions about psychoanalytic activity today; or, more particularly, about the relations between psychoanalysis and psychotherapy. Generally speaking, it is accepted that psychotherapy conducted by a psychoanalyst has better chances of success. Moreover, contributions on the face-to-face setting by authors who are experienced psychoanalysts are often of great value (see Brusset, 2005a,b; Cahn, 2002). Yet, the idea of a crisis in psychoanalysis has to be considered.

In 1999, I already had the project of writing on a subject that goes beyond the well-known problem of the difficult cases, which had already been the object of many publications. My intention was to consider the question of the failures of psychoanalysis. I had to change my mind, for reasons that I shall explain later. I noticed, not without surprise, that the bibliographical references were particularly scarce, as if psychoanalysts sought to avoid this theme. Was this because they did not want to admit to themselves or acknowledge that their activity could meet with failures? At any rate, I felt truly alone in embarking on this undertaking. Was I going to be the psychoanalyst who had revealed a well-guarded secret, and who had risked being anathematized for daring to speak a truth that one would have preferred to keep quiet about?

Fortunately, I was mistaken. For several years, I had been running a seminar on case studies posing problems for young analysts. The seminar was well attended and I had the opportunity of admiring the talent of several of the participants who had accepted submitting for discussion the difficulties that they had encountered. The cases were presented in detail, often over several sessions. For my part, I commented on the material presented each time I had the opportunity of doing so, interweaving my thoughts with those proposed by the participants. These exchanges, associating the participants’ comments with mine, were very rich. The basic rule was to take one’s time and not to feel constrained by any particular time limit. Without losing sight of the general theme of our meetings, I understood that if I wanted to publish something in connection with what had been discussed in the seminars, rather than going it alone, it would be much more interesting to join forces with my colleagues and to present their cases in order to show that we seemed to share a common concern. So, I decided to pool our respective experience. Far from seeming to be an isolated effort, this collective undertaking offered us a broader horizon for our reflections. So it was that I decided to present my colleagues’ contributions, naturally with their agreement.

What are the reasons for the impression we have that the difficulties of analysis have increased in recent years? It is difficult to say, precisely, and even more so to demonstrate that this is indeed the case. Are we not dealing, once again, with an idealization of the past? Or perhaps it will be said that the same obstacles to cure or recovery existed just as much in the past as today, but that they were less well identified. Or, alternatively, it may be thought that in the past we were content with more modest or more superficial results, without being aware of what remained unanalysed and continued to stand in the way of a more complete analysis. It is worth making a comparison here. Many analysts today accept continuing an analysis conducted by other colleagues a long time before, but which had resulted in only partially satisfying results. They venture to conduct a second or even a third analysis, which allows them to follow up the analytic work already done, and quite often to arrive at more satisfactory conclusions for the patients concerned. I, too, have experienced arrests of the analytic process, and blockages that led some patients to give up analysis. Sometimes this was because they themselves had tried working as an analyst without success, and, in other cases, it was because analysis had shown the limits of the benefits that they were able to derive from it.

While there are no statistical studies that allow us to make a valid quantitative evaluation, we can at least draw attention to certain facts and venture certain hypotheses. The first case, familiar to us for a very long time now, is that of interminable analysis. Freud discussed it in his article “Analysis terminable and interminable” (1937c). If I search my memory, I can recall a time when, for an analyst as experienced as Nacht, interminable analysis was a scourge to be avoided at any cost; to such an extent that, at the end of his career, one was surprised to see him encouraging the resistances of the patient against continuing the analysis, and pushing the analyst to precipitate the end of the treatment, to the great astonishment of those whose task it was to train others.

Alongside this technique, motivated by a phobia of interminability, Lacan opted for a different solution. We heard about his interminable analyses exceeding fifteen or twenty years, except that the sessions of these analysands, chained to their transference, rarely exceeded five minutes! Clearly, neither of these techniques coincided with our analytic ideals.

However, the generation that followed these pioneers of French psychoanalysis proved to be more ambitious. Mention should be made here, in particular, of Bouvet, whose influence was remarkable. When we refer to the golden age—if ever there was one—of psychoanalysis in France, it is noticeable that more attention was paid then than it is today to carefully establishing the indications of analysis, often after careful thought. In the case of patients who were considered regressed or too fragile, a negative decision was frequently taken with regard to analysis. Nevertheless, new ideas emerged. The first that should be mentioned was the categorization by Bouvet (1967) of genital structures in contrast with pregenital structures. This division corresponded approximately to the Oedipal neuroses in contrast with those in which fixations prior to the Oedipus complex predominate. The “good cases”, the real indications of analysis, were those in which Oedipal organizations and genital structures dominated. The transference was not too ambivalent, parental imagos were sufficiently differentiated, conflicts were centred around castration anxiety, problems related to bisexuality were limited, and, above all, the influence of aggressivity and destructivity was neither too invasive nor too much under the sway of repetition compulsion, so that an appropriate interpretation was sufficient in the majority of cases. Still more frequently, a formidable stumbling block was the discovery of a form of masochism that did not yield to the transference-analysis, while resistances persisted that were firmly anchored in the patient’s psychical organization. These often unforeseen, not to say unforeseeable surprises had discouraging effects on the analyst which he/she had to learn to anticipate and to tolerate. So, the prospect of the psychoanalytic process getting bogged down seemed less formidable, and psychoanalysis was practised increasingly for the satisfactions that could be derived from it.

But, however influential the contributions of Bouvet were (see Bouvet, 1967)—he was the author of an original conception of the object-relation founded on the notion of distance from the object—other themes aroused interest: the study of character neuroses (Diatkine and Favreau, Sauguet); the renewed description of narcissism (Grunberger); the first innovations in psychosomatics (Marty and Fain), etc. Moreover, now that Freud’s work had ceased to enjoy a veneration that brooked no criticism, Viderman (1970) did not hesitate to raise a number of questions that shook more than one of his colleagues, at least for a while. He had the weakness, however, of ignoring foreign authors belonging to the Kleinian or American movements. As for “Ego psychology”, theorized by Hartmann, Loewenstein and Kris, it did not have much success in our country. Compared with the UK, and sometimes the USA, countries to which many of Freud’s disciples had emigrated and transmitted what remained of his teaching, French psychoanalysts suffered at the time from certain limitations in their clinical experience. France had benefited from the direct teaching of analysts who had only known Freud indirectly. Marie Bonaparte had been close to him, but only had a limited influence. Certainly Hartmann, for a very short time, and Loewenstein, for a longer period, played this role of transmitters. The latter was the analyst of the pioneers of French psychoanalysis: Nacht, Lacan, and Mâle. However, after 1945, France could only count on the first generation of French analysts, who analysed the majority of the future most prominent analysts in Paris.

In addition, the civil war in French psychoanalysis between the adversaries and followers of Lacan had a sterile influence on exchanges between analysts. Without going into the details of a story that is now well known, the splits that took place in 1953 and 1963 encouraged different and sometimes opposing attitudes. Lacan succeeded in having his dissident technique accepted: short sessions, the analyst’s systematic silence, abstention from analysing the negative transference, and the application of a theory in which everything connected with the maternal transference was more or less ignored, emphasis being placed almost exclusively on the paternal transference. This new way of understanding analysis attracted a lot of people owing to Lacan’s charisma. On the other hand, those who tried a Lacanian analysis—a considerable number initially—often ended up changing analyst in order to follow more established and tested practices. Many analysands preferred to break off their Lacanian analysis and to continue their experience in more classical analytical movements. Those who had left the Lacanian School found themselves, as a result of a second split, in the ranks of the SFP (Société française de psychanalyse), which grouped together the former Lacanians and those gathered around Daniel Lagache, whose thinking was often akin to that of American analysts. Although they had separated from Lacan, relations none the less remained very distant with their former colleagues from the Paris Psychoanalytical Society (SPP: Société psychanalytique de Paris). The new style that they adopted, often influenced by by their former allegiance to Lacanian circles, did not always facilitate their exchanges with those whose training remained marked by the spirit of the Paris Psychoanalytical Society. Much time was needed before genuine exchanges took place between the societies. As for the members of the mother society, the SPP, they developed a clinical tradition that was often appreciated, but frequently criticized, of which Nacht was the leader. Later, the creation of the “Fourth Group” allowed for greater diversity and richness of contacts, especially through Aulagnier.

The Nouvelle Revue de Psychanalyse, directed by Pontalis, practised a policy of openness encouraging exchanges with colleagues of the British Psychoanalytical Society as well as with American psychoanalysts. Thanks to translations, French analysts were able to familiarize themselves better with foreign publications worthy of interest. Links were soon established between certain French analysts and their colleagues from across the Channel. Winnicott’s work created a great stir in France. Henceforth, Lacan was not the only one to represent novelty. Thanks to Winnicott’s influence, there was a revival of the technique of borderline cases. So, French analysts made the transition from Bouvet’s pregenital structures to borderline cases, which they came to understand better through their reading of Winnicott. Moreover, the work of Bion, who was analysed by Melanie Klein, was becoming increasingly widely read. An original author, Bion could not allow himself to be confined by Kleinian theory, to which he gave a decisive new impetus by developing his own way of thinking. Bion’s thought finally distinguished itself from the model that had inspired it, liberating itself progressively from its major lines of thinking in order to venture out far from its horizons. The exchange between British and French psychoanalysts is still being pursued, with limited but reciprocal interest (see Birksted-Breen, Flanders, & Gibeault, 2010). No one knows what will emerge from it, but the exchanges have deepened, and mutual understanding has been improved.

It cannot be denied, however, that in recent years there has been a growing sense that psychoanalysis is going through a crisis. It has been more frequently and more vigorously attacked by adversaries who have tried to impose new techniques inspired by cognitivism. Psychoanalysis has resisted well these vigorous assaults, which were intended to eliminate it, albeit without success. It is pursuing the advances of its caravan without being troubled by the rantings of its detractors. Today, it is still doing well.

Chapter Two
Lacanian thinking on language

I have expressed myself on various occasions on Lacan’s ideas concerning the relations between language and the unconscious. I have made a number of contributions to the subject, of which one, in 1983, treats of the problem in detail. I have come back to this topic several times, in particular in 2005, in the preface to Castarède and Konopczynski’s book Au commencement était la voix (Green, 2005) and more recently still, in 2007, in an article “Langue, parole psychanalytique et absence”, published in the Revue française de psychanalyse (Green, 2007a).

Language in psychoanalysis (Green, 1983a)

Around 1950, French psychoanalytic thinking turned towards the study of the relations between language and the unconscious under the influence of the structuralist movement. In 1953, Lacan presented his Rome Report, “The function and field of speech and language in psychoanalysis” (Lacan, 1966), an event that coincided with the split which divided the SPP and the future SFP. The allusions in this text linking psychoanalysis to structuralism are rare. It is only in the second half of the Rome Report that one comes across any mention of the thinking of Lévi-Strauss, and the proposition: “This law reveals itself clearly enough as identical to a language order” (Lacan, 1966, p. 229). The allegiance to the work of Lévi-Strauss would not be returned. The latter waited until Lacan’s death to explain himself. He subsequently admitted that he had never understood anything of what Lacan was writing about, while stating his disagreement with the theoretical foundations of psychoanalysis (see Lévi-Strauss & Eribon, 1988, pp. 107–108; also Green, 2008). But this was only one stage for Lacan. He strived to pursue the linguistic inspiration by extending it towards mathematics. Psychoanalysis was supposed to open up a “first language” for us. He cited the example of poetic texts, justifying an investigation into poetics (Lacan, 1966, p. 244). And he reminded us opportunely that the function of language is not to inform but to evoke (ibid., p. 247).

The relations between Lacan’s thought and structuralism are not clear. It has been debated in turn how he differentiated himself from it and how he belonged to it de facto (Miller). Those who analysed his thought—of whom I was one—nevertheless finally understood the role that Lacan attributed to linguistics, before detaching himself from it because the linguists had not followed him. So, he then called it “linguisterie” out of derision. But before arriving at this irrevocable condemnation, it wa...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• PSYCHOANALYTIC IDEAS AND APPLICATIONS SERIES
• ACKNOWLEDGEMENTS
• Dedication
• ABOUT THE AUTHOR
• PREFACE
• INTRODUCTION
• PRESENTATION
• PART I: THEORETICAL STUDY
• PART II: CLINICAL STUDY
• PART III: ILLUSIONS AND DISILLUSIONS OF PSYCHOANALYTIC WORK
• REFERENCES
• INDEX