The Therapist at Work
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The Therapist at Work

Personal Factors Affecting the Analytic Process

Dimitris Anastasopoulos, Evagelos Papanicolaou, Dimitris Anastasopoulos, Evagelos Papanicolaou

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eBook - ePub

The Therapist at Work

Personal Factors Affecting the Analytic Process

Dimitris Anastasopoulos, Evagelos Papanicolaou, Dimitris Anastasopoulos, Evagelos Papanicolaou

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About This Book

Dimitris Anastasopoulos and Evangelos Papanicolaou have gathered together a distinguished group of contributors to focus on the therapist's participation in therapy and the influence of personal factors on the therapeutic relationship. The majority of the papers grew out of the proceedings of the fourth EFPP Congress of the Adults Section in 2000 and explore the therapist-patient relationship with the emphasis on the influence of the therapist as opposed to that of the patient. Topics discussed in this collection include the impact of the patient on the analyst, how the analyst's clinical theory and personal philosophy affect the analytic process, the effect of the therapist's dreams on the therapeutic process, the psychoanalyst's influence on the collaborative process, and intersubjective phenomena and emotional exchange in the psychoanalytic process. Certain papers focus mainly on theory while others are more clinically-oriented. This volume presents an overview of historic and current thinking and aims to generate yet more discussion on this evolving and important issue. It will be of interest to practicing and training psychotherapists.

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Publisher
Routledge
Year
2018
ISBN
9780429922442

CHAPTER ONE
The analyst's clinical theory and its impact on the analytic process in psychoanalytic psychotherapy

Joachim KĂźchenhoff
The 2000 EFPP Congress in Cyprus was devoted to the important issue of what the psychoanalytic psychotherapist contributes to the analytic process. My chapter addresses the question as to how far the analyst's theories influence the course of the therapy. I assume that we would all readily agree that there is an influence. But it is not at all easy to clarify the ways in which these influences work.
First, we have to define what we understand by theory—the first part of my discussion is devoted to that question. Four levels of theory are introduced:
  1. the analyst's philosophy or Weltanschauung;
  2. his/her general approach to life and to therapy—his/her psychoanalytic ideological background;
  3. his/her metapsychology—the clinical theory;
  4. his/her conscious or preconscious theorizing activity (Barratt, 1994) when engaged in a session with an analysand.
The second part of my discussion deals with Levels 2 and 3: the analyst's metapsychological and clinical theories. It will be shown that psychoanalytic theory—like any scientific theory—is bound to general epistemological principles, as have been formulated by the philosophy of science. For example, basic rules have to be considered as to how a theoretical approach affects the data that are observed. The epistemological considerations will lead to three conclusions:
  • Neither in psychoanalysis nor in any other science are observations independent of the theories that set the frame for any possible observation.
  • Thus, different theoretical frames produce different data.
  • These different theories may or may not always exclude each other. It is a task for every therapist but also for psychoanalytic metapsychology as a science to decide whether a pluralistic approach—one that takes a variety of theoretical frames to be equivalent and simultaneously valid—is appropriate and when theoretical frames cannot be mediated with each other and therefore cannot be valid at the same time.
Part three of my chapter addresses Level 4, the analyst's theorizing activity—that is, the (pre-)conscious production of explanatory or interpretative theories coming to the analyst's mind in the course of the session or in between sessions. This activity is not just an application of the analyst's clinical theory or metapsychology in a concrete clinical situation. Obviously it depends on it, but not totally: there are other factors influencing the analyst's theorizing activity as well, which may be unconscious and may stem from identificatory processes with his/her training analyst, with his/her supervisor, with group dynamic processes in the psychoanalytic peer group, and so forth. And finally, the theorizing activity may be due to countertransference influences. Thus, an inversion seems to take place: theory at this level is not only a determining factor but is itself determined by the psychoanalytic process.
If we take this finding seriously, we have to reflect on a peculiar interaction of theory and clinical practice in psychoanalysis: first of all, the very hypothesis of unconscious processes undermines theory formations that are products of conscious activities. Second, theory does not always come first—it cannot claim priority over clinical practice. Theory pre-figures clinical experience but, at the same time, is subverted by it. The fourth part of this chapter tries to deal with this special epistemological issue: this subversion of theory that in itself is a theory needs to be understood. I shall begin here by returning to the first theoretical level and raising the question as to which Weltanschauung or philosophy might be appropriate to account for this obvious paradox. I offer an answer by suggesting that pluralism is not a sufficient epistemological basis for psychoanalysis. Deconstructivism seems to be more appropriate, because it allows us to conceptualize these theoretical paradoxes.

Part I

The title of my chapter addresses the "analyst's theory"—what do we mean by it? We have been used to differentiate between clinical theory and metapsychology. Metapsychology is a theory of clinical theories—that is, it summarizes the principles underlying clinical theories. These provide the nosological concepts, the therapeutic rules, and so forth. For example, the concept of defence can be understood within the metapsychological frame of Freud's structural model. As an application of this model, hysteric phenomena can be understood to be the result of specific defence mechanisms, conversion and repression; this would be a clinical theory.
As is known, there have been recurring discussions as to whether metapsychology should be discarded altogether. Instead of reducing the spectrum, I want to broaden it by adding two more levels of what theory is in psychoanalysis. On the one side, at the abstract or general end of the spectrum, there is the level of the Weltanschauung or anthropology or philosophical basis for psychoanalytic theories. We have to consider this level, as the metapsychological approaches we use are variable; there is no longer one unitary metapsychology. So, whatever approach we choose depends on the general principles we use as theoretical or practical guidelines in our lives. Whether the psychoanalytic cure is regarded as a method by which to confront the subject with the contingencies of reality, with the unsurmountable limitations of phantasmatic omnipotence, and with the necessary frustrations of life, or whether it is seen as a chance to free repressed drives or affects from repression, this choice of a metapsychological concept is in itself formed by an ideology or anthropology that most of the time remains unnoticed. On the other end of the spectrum, there is the analyst's theorizing activity—that is, his/her activation of theoretical material during a session or—in broader terms—during the course of a psychotherapy. Under ideal conditions, the four levels should correspond with each other, each supplementing the other without producing incompatibilities between the levels. To return to the example just given: if an analyst has adopted a philosophical ideology of thoroughgoing liberalism, he/she might be more prone to choose drive psychology as a metapsychological basis. His/her clinical awareness will be directed to corresponding clinical material—for example, he/she will eagerly notice resistances against hidden drive impulses and wishes, and his/her theorizing activity within the sessions will be directed towards the hidden manifestations of oedipal or anal or oral forces which need to be set free. We all know that this top-down correspondence of the four theoretical levels does not work in real practice. We do not give interpretations in a strictly deductive way. In a therapeutic session, as analysts we do not concentrate on material best fitting our clinical theory. And if we do, we do not hesitate to reflect on this somewhat obsessive-compulsive countertransference approach. If our awareness or responsiveness (Sandler, 1992) is free-floating, our theorizing activity will lead us to concepts quite remote from our general convictions. Clinical experience is richer than the theoretical concepts we have; it may stimulate new and spontaneous ad hoc theories that might be at odds with the prefigured theoretical notions. I shall return in the last part of the chapter to this important issue of a reversed relationship of theory and clinical practice in psychoanalysis. Up to now, we only need to remember the four levels of theory and the fact that there might be tensions between the levels that should not only provoke disturbances but might be seen as a source of creativity in psychoanalysis.

Part II

Reading Freud's technical papers, one could have the impression that psychoanalysts do not need to reflect on their theories in clinical practice. As theories are products of conscious rational activities, they should be set aside as best one can because they interfere with the capability to receive the unconscious dimensions of the patient's discourse. The analyst, according to Freud, attempts "to avoid as far as possible reflection and the construction of conscious expectations" and he should "try not to fix anything that he heard particularly in his memory" (Freud, 1912e, p. 112). Bion's demand that the analyst should listen without memory and desire seems to foster this argument (Bion, 1967). Nevertheless, these recommendations cannot be taken as epistemological arguments advocating a "transaudition" (hearing through) of unconscious material in any more or less mystical form. Rather, they are meant as warnings not to contaminate the free-floating awareness too early by material that has fixed itself in the analyst's mind, preventing further open-minded listening. Instead, psychoanalytic practice is bound to the epistemological rules valid for each science or therapeutic theory. It is worth while to remind ourselves of some of them because they help to clarify how clinical observations are prefigured by theory.
  1. It is an epistemological truism to state that data are not independent of the concept by which they are evaluated. There is not a reality outside our grasp that can be observed by an independent observer. Theories not only interpret data but generate them. Having different metapsychologies and clinical theories at our command, we have to realize that different theories create different sets of data. According to the approach we choose, we obtain different analytic processes. No doubt a Lacanian psychoanalyst listening to the significant words in the verbal material obtained by free association will influence the session in another direction compared to the object-relations' adherent who wonders what part-object representations have been projected onto him by the patient and what patterns of unconscious relationship have emerged throughout the session (cf. Gill, 1997b).
  2. What is put into question here is scientific truth as well as clinical adequacy (cf. Protter, 1988). If our theoretical approach prefigures the analytic process, it might seem to be difficult to counter the verdict that psychoanalytic effects are due to suggestion: if the theory chosen by the analyst yields specific data, this theory obviously serves as an instrument to manipulate the analysand according to the theoretical presuppositions the analyst has. Yet epistemology itself can be helpful in answering this verdict: the influence of the theory on the generation of data is true for any science, including the natural sciences. That different psychoanalytic theories yield different processes is not a weakness of psychoanalysis as a science but an epistemological necessity shared by all sciences.
  3. Data are constructs: they are—as the word "datum" implies— given, at hand, they do not exist a priori. They are constructed by the perspectives chosen beforehand, and even that which is defined as an object or as a datum is bound to the preliminary discourse setting the framework for what is to appear and what is to be beyond it. Therefore, it would be wrong to state that we have different perspectives of the same data if we compare different psychoanalytic concepts. Instead, we have to state that different data are created by different frames. This statement has implications for the question of what can be regarded as the truth. If there is not an independent object—an analysand with unconscious demands irrespective of the analytic process—but only this patient within this concrete given setting, then it does not make sense to maintain the option of the one analytic truth. In fact, there is a variety of more or less valid approaches. And even this formulation could be misleading: there is no concept of validity that is independent of the theoretical preconceptions. Instead, what is valid is due to the needs defined beforehand: do we aim at supporting the patient pragmatically by our interpretations? Or do we regard as valid only those interpretations that have a subjective evidence for the patient? Or is an interpretation valid only if is able to provoke more material which has been unconscious so far?
Let me quickly draw a few clinical consequences from these somewhat abstract considerations:
  1. Instead of giving up theory, we need more theoretical reflection as psychoanalysts. If our metapsychological and clinical preconceptions take part in generating the clinical experiences we have, we need to be aware of them. As they are so influential, they should become explicit; only then can they be reflected upon or criticized if necessary. We should train ourselves to become aware of the implicit theoretical pre-concepts we use. I return to Bion's famous prescription to enter the session without memory and desire. Even if we succeed in not thinking of anything, we still adhere to this very theory—that is, Bion's remarkable theory of thinking as the metapsychological background to our concrete clinical attitude. So it is not only the content of what we think or what we observe but also our attitudes which should be questioned as to their background concepts.
  2. If we use competing metapsychological or clinical theories, each of which influences our clinical awareness, we should feel an obligation towards theoretical consistency, adequacy, and actuality. If we make our background theories explicit we should perform—sit venia verbo—a regular check-up on the theories we use. Do they contradict each other? Are they up-to-date? Which of the theories should be dropped, even though it might have become a good companion to everyday work, simply because it is no longer in line with present-day developments of psychoanalytic theory or the results of psychoanalytic research? I fear we are—as individual therapists as well as a scientific group—still reluctant to criticize our sets of theories in this way or even to discard some concepts because they must be regarded as outdated.1
  3. Even so, we will not end up with a unitary metapsychology. I do not regard such a unity as an ideal option or aim. Instead, we have to accept, as Strenger (1991) maintains, a theoretical pluralism in psychoanalysis. We have to live with a variety of theoretical approaches which cannot be reduced further. These then are, in Nelson Goodman's sense (1978), different ways of (psychoanalytic) world-making. Psychoanalytic concepts, seen from a pluralistic perspective, offer "conceptual frames which organize phenomena in different ways" (Strenger, 1991, p. 71), and each frame offers specific and rich clinical perspectives. Pluralism, as Strenger rightly states, has nothing whatsoever to do with relativism or scepticism; pluralism does not stem from a sort of metaphysical resignation that the ideal of a unitary theory cannot be achieved, either now (Spence, 1982) or ever (GrĂźnbaum, 1980). It accepts theoretical variety as a fact and regards it as a source of theoretical enrichment. And it does not support a dogmatic view that maintains the option of and privileged access to the one and only truth.

Part III

Up to now, it seems as if psychoanalysis could readily be handled like any other science in epistemological terms; maybe we would have to include some hermeneutic rules as well, It seems as if with the concept of pluralism all epistemological problems have been solved. Thus we have come to know that there are several psychoanalytic ways of world-making. We have come to realize that the analysand's unconscious notions never appear independently of the methods by which we address such unconscious experiences. We have come to accept that there is a mutual enrichment process going on between theory and clinical experience, the one stimulating progress in the other.
As pluralistic psychoanalysts we could regard ourselves as some peculiar sort of epistemological "chameleons", changing colours whenever we feel the need to do so, having different sets of explanations and interpretative formulas at hand that can be activated according to clinical necessities.
Turning now, in the third part of my chapter, to the theorizing activity of the analyst within the sessions as the most concrete form of theory formation in psychoanalysis, we have to realize all the same that this theorizing activity is not only a factor of influence on the psychoanalytic process. It is itself influenced by several factors, of which I shall mention only two: namely, extra-analytic influences and intra-analytic, transference-bound influences.
(1) It was Sandler (1992) who pointed to an important difference in the formation of the analyst's theory: he spoke of the public as opposed to the private face of psychoanalytic theory. What one admits in public—may that be case conferences, scientific papers, supervisory sessions, or the like— to doing may be different to what one actually does in a given therapeutic session. This is partially so because there are other, more hidden influences on the theoretical approach that the analyst develops in the session, some of which may be unconscious and may be detrimental to the analyst's analytic capacity when they are not made conscious and worked through (cf. Grossman, 1995). If an analyst claims himself to be Lacanian in public debates and if the same analyst has had a training analyst working according to object-relations theory, he might in clinical practice be much more object-relationist than he would be willing to admit. The discrepancies may remain unnoticed for a while, especially when unconscious identifications with the training analyst have not been solved. If the peer group within a psychoanalytic institute supports ego psychology whereas an analyst himself does not think it helpful in proper analysis, ego-supporting strategies may be used all the same, out of fear of not obeying the unwritten rules of the training institute, while ego psychology continues to be criticized in a sharp voice.
These examples show that in everyday practical work as psychoanalytic psychotherapists, we do not change colour according to consciously reflected necessities only, but that our colours change even before we may become aware of it. Granted that our theories influence the therapeutic process, we should be alert in the other direction to all the influences on our theorizing activity itself. If not, these hidden influences will be detrimental inasmuch as they remain unnoticed.
(2) Let us turn to the intra-analytic influences on the theorizing activity—that is, the influence of transference and countertransference on the analyst's thinking and theorizing capability. Though it might seem trivial in clinical terms, this influence is most important in conceptual terms, as I shall demonstrate shortly. It is a familiar experience during supervisions: the analyst's theorizing is revealed as a defence—maybe the analyst wants to protect him/ herself from drive cathexes in transference by highlighting the narcissistic pathology all the time. Or the analyst insists in some form on the patient's accepting his/her interpretation by repeating it all the time; this might be due to a couritertransference need—the analyst needs the patient's approval of everything he/she does, thus inverting the Bionian containing process: the patient is summoned to contain the analyst's thought instead of vice versa. Maybe the analyst's theorizing can be understood as his/her desire to be "the one who knows". This time the analyst is unconsciously led to replace—speaking in Lacanian terms—the analytic discourse by a master discourse ("discours du maitre"). In all instances, the pivotal point is similar: the analyst's theorizing can be shown to be an acting out of libidinal or narcissistic desires on the analyst's side.
Because it is central to the argument I want to make, let us now consider more closely Bion's theory of how the analyst gives an interpretation. As you know, it was Bion's aim to conceptualize a psychoanalytic theory of thinking, and this endeavour has stood the test of time in more than one respect: it is more topical today than ever. Bion outlined a genuinely psychoanalytic theory of thinking, and this makes it so important to us. Bion was aware that psychoanalytically there is no way to conceive of the analyst's theorizing or interpreting activities in only rational terms. According to Bion (1962), the act of interpreting is itself a conception; note the double meaning of the word here. The analyst uses his theory as a pre-conception, as a form or container, that meets the content that is being offered b...

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