Contemporary Bionian Theory and Technique in Psychoanalysis

Antonino Ferro

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781317590163
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Psychoanalytic theory has developed very rapidly in recent years across many schools of thought. One of the most popular builds on the work of Wilfred Bion. Contemporary Bionian Theory and Technique in Psychoanalysis provides a concise and comprehensive introductory overview of the latest thinking in this area, with additional contemporary theoretical influences from Freud, Klein, and Winnicottian thought.

Through explorations of the history, theory, and clinical practice of psychoanalysis, Ferro and contributors reveal the changes and developments it has undergone in the research laboratory of the consulting room. Contemporary Bionian Theory and Technique in Psychoanalysis brings together the theories, clinical practice, and techniques that have gradually been developed in a variety of cultural contexts, exploring how they are understood, clarified and enriched by various analysts in daily practice. The book is circular, opening many paths of access to the reader. It aims to revive an experience of creative dialogue exactly as occurs in analysis when two minds think and dream together to transform each other reciprocally. The book sets forth, for instance, a new model of the mind called the oneiric model, taking inspiration from Bion's conceptualizations and field theory.

Covering central psychoanalytic concepts such as transference, dreams and child analysis, this book provides an excellent introduction to the most important contemporary features of Bionian theory and practice. Contemporary Bionian Theory and Technique in Psychoanalysis will appeal to ppsychoanalysts and psychotherapists in training and practice, as well as students of psychiatry and psychology.

1
THE SETTING AS A LOCUS OF POSSIBLE TRANSFORMATIONS

Maurizio Collovà

1.1 The setting

The concept of setting has been and continues to be one of the fundamental crossroads in the dialogue between theory and technique in psychoanalysis, and even today stands as a locus of profound changes. We can see immediately how Freud himself reflected on the meaning of his extraordinary intuition, in part because of different interpretations given to it by his students.

The application of Freud’s ideas by his followers often surpassed Freud’s own intentions in terms of rigidity. This point emerges clearly from the extreme caution with which Freud offers his ‘recommendations’. In his 1913 work On Beginning the Treatment he writes:

I think I am well-advised, however, to call these rules ‘recommendations’ and not to claim any unconditional acceptance for them. The extraordinary diversity of the psychical constellations concerned, the plasticity of all mental processes and the wealth of determining factors oppose any mechanization of the technique.

Freud, 1913, p. 123

Later, in a letter written in 1928 to Ferenczi, he would say:

I thought that the most important thing was to underline what should not be done and to highlight the temptations that might put the analysis in jeopardy. Just about all the positive things one has to do I leave to tact […] the result is that docile analysts do not realize the elasticity of the rules I have written, and submit themselves to them as if they were taboos. One time or another all of this will have to be revised […].

cit. in Nissim, 1988, pp. 605–683

One is reminded here of the question Bion posed in the last lines of his famous work Making the Best of a Bad Job (Bion, 1979, p. 331):

Will psycho-analysts study the living mind? Or is the authority of Freud to be used as a deterrent, a barrier to studying people? The revolutionary becomes respectable – a barrier against revolution. The invasion of the animal by a germ or ‘anticipation’ of a means of accurate thinking, is resented by the feelings already in possession. That war has not ceased yet.

Freud, contrary to the concerns he expressed in relation to future analysts, chose the path of constant revision of his own ideas on the basis of clinical observation and observations of his own mistakes, even though, as was his wont, he allowed levels where the old and the new could co-exist. What he says about the setting in the opening lines of his fundamental work Recommendations to Physicians Practising Psycho-analysis (1912) offers proof of this:

The technical rules which I am putting forward here have been arrived at from my own experience in the course of many years, after unfortunate results had led me to abandon other methods that I had undertaken […]; I must however make it clear that what I am asserting is that this technique is the only one suited to my individuality; I do not venture to deny that a physician quite differently constituted might find himself driven to adopt a different attitude to his patients and to the task before him.

Freud, 1912, pp. 109–120

This passage gives the reader an idea of the air of freedom as well as the openness and curiosity towards other ideas that can emerge due to the different personalities of different analysts. We appreciate Freud’s curiosity, his interest in experimenting and his willingness to modify his assumptions in the knowledge that he was making a revolution, that he was bringing ‘the plague’ – as he put it when he landed in America in August 1909 together with Jung and Ferenczi (Freud, 1909). Certainly, in making these points, Freud was being receptive to a productive ambiguity and, at the same time, offering interesting reflections on the difference between style and technique. Horacio R. Etchegoyen (1986) is more inclined to believe that technique contains within it something universal and that style on the other hand is subject to personal changes. Practices are personal, characteristic of the style of each analyst; for example, the way of greeting the patient, either by shaking hands or simply with a facial expression, is a matter of style. Other recommendations Freud made arose from his personal needs and became fully part of the classic and rapidly shared technique, such as the position of the patient on the couch out of sight of the analyst.

It is well known that throughout the history of psychoanalysis there have been many theoretical concepts that were regarded first as encumbrances but then later as tools for the development of the theory and technique of psychoanalysis. As we shall see, the concept of setting is not exempt from these vicissitudes, especially in relation to the theoretical reference model of the analyst.

1.1.1 Opposite sides of the debate about setting

To help us get our bearings I shall now describe the polarities that encompass the changes that have occurred over a century of psychoanalysis.

The quotations I shall be using are simply meant to show the distance between Freud’s initial ideas and, in part, current thinking. They are thus not exhaustive reflections of the positions taken by their authors, nor of more recent further developments. It goes without saying that the respective points of view, in their diversity, are still today represented within the overall international psychoanalytic panorama.

The first two quotations are about the formal (also known as the external) setting, which I shall later describe in more detail.

a)Freud (1913, p. 134): ‘I hold to the plan of getting the patient to lie on a sofa while I sit behind him out of his sight.’

b)Bion (1975, p. 4): ‘We have here these chairs, this couch, because you might want to use any of them […] That is why this couch was here when you first came. I wonder what has made you discover this today.’

The second two quotations regard the internal setting; in other words, the conditions that regulate the analyst’s mental presence, listening activity and involvement during the session.

a)Freud (1912, p. 118): ‘The doctor should be opaque to his patients and, like a mirror, should show them nothing but what is shown to him.’

b)Ogden (2005, p. 5): ‘The analyst […] must possess the capacity for reverie, i.e., the capacity to sustain over long periods of time a psychological state of receptivity to the patient’s undreamt and interrupted dreams.’

The last quotations concern the information provided by the analyst to the patient, relative to the fundamental rule of free association.

a)Freud (1913–1914, p. 344), when explaining the fundamental rule, addresses his patient at the beginning of analysis as follows: ‘Finally, never forget that you have promised to be absolutely honest and never leave anything out because for some reason or other it is unpleasant to tell it.’

b)Ferro (2014, p. 14): ‘At the beginning of my work as a psychoanalyst I gave this information to the patient. […] Now at the first session, if there is a very long silence by the patient or a difficulty, only then do I intervene often in a very unsaturated way with “so now?” And other times, “of course you can say what’s on your mind” and sometimes with an interpretation of the atmosphere which I think has been created.’

For all their diversity and distance from each other, these modalities obviously rest on a theoretical foundation that is consistent with what they have taken from practice and theoretical developments at that precise moment in the history of psychoanalysis.

1.1.2 How the psychoanalytic situation came about historically

In Studies on Hysteria by Breuer and Freud (1892–1895) one can follow the rapid development of the techniques Freud used on his patients, from Emmy von N., with whom he worked using hypnosis, electrotherapy and massage, right up to Elisabeth von R., with whom he did not use hypnosis but an intermediate method halfway between that used by Breuer and psychoanalysis proper. Freud used to apply pressure with his hands on the patient’s forehead to stimulate her into remembering, thus setting up the method of ‘associative’ or suggestive pressure, a step towards psychoanalysis. The initial ‘breakthrough’ moment of 1897, which reflected a certain discontinuity from the hypnotic and cathartic matrix, is where Freud abandons the suggestive gesture of hand pressure and places himself behind the patient, avoiding visual control and any possible physical contact. Freud leaves the mind of the patient free to associate and to follow emerging thoughts, thus inaugurating the method of ‘free association’. By the same token, when listening the analyst is called upon to proceed ‘as it were, without any purpose in view, allow[ing] oneself to be taken by surprise by any new turn in [cases], and always meets them with an open mind, free from any presuppositions’ (Freud, 1912, p. 114). These changes in technique occur as a result of the discovery of two phenomena. The first is the recognition that traumatic seduction is the cause of a split in consciousness. A particular event is not accepted by consciousness because it is too painful. The fact that, under pressure of association, forgetfulness occurs also gives Freud confirmation of ‘resistance’, a second phenomenon that leads to the technique of free association, which was later to become a ‘fundamental rule’.

As we know, various basic elements of psychoanalytic treatment have contributed to the brilliant invention that is the setting. These include the creation of conditions of continuity and stability of the session as a guarantee to both patient and analyst; the reduction of any element of disturbance or interference in communication between patient and analyst; promoting the regression of the patient; an effect that protects the patient from the incursions of the Real; and sanctioning a moment of the suspension of action. Other factors, as Freud himself suggested, included the analyst’s sense of annoyance at being watched while his mind is engaged in listening to the patient’s free associations and his thoughts are wandering as they spin threads of association. The discovery of the theory of transference was then to open the way to new variations in technique.

1.1.3 The setting intersects with transference

The setting finds itself at a new major intersection with the discovery of the theory of transference, which defines more clearly the relationship between analyst and patient.

With the case of Dora, written in 1901 and published in 1905 under the title Fragment of an Analysis of Hysteria, Freud began to understand the phenomenon of transference, as he noted how resistance¹ manifested itself in the presence of the analyst. In reference to the epilogue to the case of Dora in 1901 Freud wrote, ‘I did not succeed in mastering the transference in good time […]. Thus she acted out an essential part of her recollections and phantasies instead of reproducing it in the treatment’ (Freud, 1901, pp. 1–122). Analytic practice had brought Freud face to face with demands for love, some explicit, some sublimated, from his patients. Knowing that these successes were not due to his actual charm, he presumed that other factors might be at play. Freud realized that the feelings expressed in this way, including hostility and aggression, came out in proximity to repressed complexes, and that a mistaken mental association meant they were seen in reference to the person of the analyst. For these reasons, he gave this phenomenon the name of transference.

The point to emphasize here is the emergence of the need for the analyst to make a change in his technique, in his way of being in the analytic situation or setting that now must include an intervention, in other words, an interpretation of the resistances and the defences the patient deploys to maintain them, of the original relationship and lastly of the transference on to the analyst of impulses and feelings experienced in the form of a re-iteration of the past. This process helps in developing the treatment and in resolving the neurosis.

1.1.4 Analytic situation and the archaeological model ²

At this point, mention should be made of the historical age Freud was living in. This was a period that saw the rapid expansion of great archaeological discoveries. Already in Studies on Hysteria (Breuer and Freud, 1892–1895, p. 293) the Freudian model incorporated the archaeological metaphor:

Thus it came about that in this, the first full-length analysis of a hysteria undertaken by me, I arrived at a procedure […] of clearing away, […] which we liked to compare [with] the technique of excavating a buried city.

A splendid example of how this view of things was further enhanced and of the use of the archaeological metaphor can be found in Freud’s 1906 work Delusion and Dream in Jensen’s Gradiva. The metaphor assumes a layered conception of the unconscious and of the repression that takes up residence there, but which the transference brings back to light in all its drama, like a living relic. This condition requires the creation of an analytic situation capable of producing a regression by the patient that facilitates its re-emergence, the discovery of a buried traumatic truth and the consequent resolution of the conflict.

Freud’s abandonment of the traumatic model, in other words of the biographical value of the trauma, opened up new developments in psychoanalysis that would take into account unconscious fantasies – a world influenced not only by real-life events but also by events belonging to the interior world. Psychoanalysis searches for the content, the real events or emotional experiences that are supposed to emerge from the depths, and tells us what happened in the life and/or the mind of the patient. In this setting, the analyst is still the mirror-analyst, the off-screen voice, someone who has to be very careful to avoid any involvement, imagined as something that might pollute the emerging material and the transference, and who has an investigative task. The analyst looks for clues, organizes them in his mind and makes sense of them through his interpretation, perhaps after long silences.

It seems obvious that this view, albeit conceived in terms of the presence of two people in a room, has a value within a uni-personal perspective in which the object of the analysis is the patient’s unconscious and his inner world. From this perspective, the analyst-mirror allows the patient, through the transference, to project onto him his or her own unconscious fantasies. The analyst is required to put himself in a state of mind of ‘free-floating attention’ while the patient is supposed to comply with the recommendation to follow his ‘free associations’, without making a selection of the material that comes into his mind.

1.1.5 Description of the classic setting

Concretely, by classic setting we mean a device consisting of stable formal elements, such as the layout of the room, the position of the couch for the patient and the chair for the analyst, and others agreed and communicated to the patient during the so-called contract. Among the rules spelt out in the contract are the frequency of sessions, their duration, the fee, the payment method, holiday breaks, the sessions paid or not paid in the event of either the patient or the analyst being absent, the possibility of future changes in fees and, lastly, elements of the mental structure, often called the internal setting, vis-à-vis which for a certain period in the history of psychoanalysis a necessary but unrealistic neutrality was advocat...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Contributors
• Introduction
• 1 The setting as a locus of possible transformations
• 2 Spectres of transference
• 3 Psychoanalytic interpretation and clinical dialogue
• 4 Dream model of the mind
• 5 From dream to dreaming
• 6 Variations on a theme: child and adolescent analysis
• 7 The vicissitudes of the analytic field
• Index