Psychoanalytic Work with Families and Couples

Clinical Perspectives on Suffering

Susana Kuras Mauer, Sara Moscona, Silvia Resnizky

• Publisher: Routledge
• Year: 2019
• Print ISBN: 9780367313203
• eBook ISBN: 9781000556582
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Psychoanalytic Work with Families and Couples rethinks the ways in which conflicts present today in psychoanalytic consulting rooms and the nature of suffering in family, couple, and sibling bonds.

Based on two major concepts, that of device (drawn from the philosophers Foucault, Deleuze, and Agamben) and that of link (developed by Berenstein and Puget), the authors have developed new approaches to clinical practice with families and couples that focus on the complexity, singularity, and immanence of patient-analyst interaction in the session. In thinking about link dynamics, moreover, they go beyond the consulting room to reflect on how these dynamics develop in other spaces, such as institutions, organizations, and the fraternal circle of colleagues.

Part I, Couples and Families Today, discusses changes undergone by families and couples in the last thirty years and their effects on psychoanalytic practice. Attributing a link logic to suffering and to the situations that condition it implies making significant decisions regarding our clinical strategy, our choice of a device and of an interpretive path. Faithful to the idea that the clinical dimension calls for transformations, the second part, Facing Clinical Challenges, includes clinical materials from manifold treatment devices that attest to changes both in contemporary paradigms and in the professional lives of psychoanalysts.

Psychoanalytic Work with Families and Couples will be of great interest to all practicing psychoanalysts and psychoanalytic psychotherapists.

Part I

Couples and families today

Chapter 1

Clinical devices

Philosophies of devices

To ponder twenty-first century psychoanalysis, we must consider both its foundations and the changes it has undergone over time. Current subjectivity conflicts and the way they are expressed through symptoms, our culture’s anxieties and discontents, and subjects’ need for the support of fraternal wefts are part of this book’s itinerary. Conceiving of psychoanalysis as a heterogeneous network entails prioritizing not only the theoretical-clinical aspect of our practice, but also institutional life, the politics of power, and the focal points of resistance, which are also its raw material.

According to Foucault, subjectivity, knowledge, and power are interconnected chains of variables whose boundaries are poorly defined. This author seeks to analyze the mechanisms whereby power is wielded. In contrast to the caricature of an essentially repressive power, Foucauldian analysis brings to light the latter’s eminently productive nature, insofar as it constitutes a play of forces that transcend violence. It is no longer a power that “makes die and lets live” but, instead, a power to “make live and to let die” (Foucault, 2003, p. 240), in other words, a “biopower.” Its productive dimension is inextricably bound to another of its constituting traits – its capillarity. In fact, Foucault does not see power as the practice of a mode of domination emanating from a single transcendent, centralized point. Rather, power traverses the entire social fabric through myriad small centers and is exerted across them. This is what the French philosopher calls the microphysics of power.

Our clinical practice challenges us to understand how this microphysical biopower operates in the various devices we inhabit and guides our interventions. When we listen to our patients today we are listening not only to the vicissitudes of transference, but also to the link mode of patients with significant figures in their environment, the contingencies of our historical period, and the context in which we are all immersed.

We need to consider twenty-first century psychoanalysis in view of its original fundamentals and also the transformations produced in it as a result of its immersion in the cultural context of its epoch and the general training of its professionals.

The notion of device was introduced by Foucault and taken up again by authors such as Deleuze and Agamben. We believe that their reflections around this notion constitute a good starting point for our inquiry because they resonate with our ways of practicing psychoanalysis.

The concept of device¹ in Foucauldian thought refers to “the set of practices and mechanisms … that aim to face an urgent need and to obtain an effect” (Agamben, 2009, p. 8). Foucault defined it as follows in “Knowledge and Truth”:

What I’m trying to single out with this term is, first and foremost, a thoroughly heterogeneous set consisting of discourses, institutions … laws … scientific statements, philosophical, moral, and philanthropic propositions – in short, the said as much as the unsaid. Such are the elements of the apparatus. The apparatus itself is the network that can be established between these elements.

(quoted in Agamben, ibid., p. 2)

Based on this definition, we would like to highlight three features of the device, namely, its strategic nature, heterogeneity, and reticular quality. We argue that in each clinical case, opting for a specific approach involves the construction of a device that weaves together a network of variables spanning a wide range, from the vicissitudes of the transference to socio-cultural marks.

Device, in this sense, means the materialization in a specific system of this network of unpredictable connections among singular elements. For instance, a man with a fishing rod constitutes a device, and the same man with a fork, a different device. In other words, elements change depending on the relationships – the connections – they establish with other elements. The device, then, is a system, a network of relations whereby singular elements acquire and produce new significations. With regard to our clinical work, individual, couple, family, and sibling interviews may be part of the same device. Each of these alternatives will shed light on different areas in the web of links.

Deleuze analyzes each of the lines making up the device and draws some conclusions. He argues that devices are

composed of lines of visibility, utterance, lines of force, lines of subjectivation, lines of cracking, breaking and ruptures that all intertwine and mix together and where some augment the others or elicit others through variations and even mutations of the assemblage. Two important consequences ensue for a philosophy of apparatuses. The first is a repudiation of universals… . The second … is a change in orientation, turning away from the Eternal to apprehend the new.

(Deleuze, 2006, pp. 343–344)

As psychoanalysts, we reject universals in two different ways. We are concerned with the uniqueness of each case, and we advocate for the need to make room for the new, that is, for what lies outside repetition.

The device: a skein

“First of all,” stresses Deleuze when he defines the device,

it is a skein, a multilinear whole. It is composed of lines of different natures. The lines in the apparatus do not encircle or surround systems that are each homogenous in themselves, the object, the subject, language, etc., but follow directions, trace processes that are always out of balance.

(Deleuze, 2007, p. 338)

A skein is something that presages more than one potential fate. In any case, it lends itself to be turned into something. For instance, it is, potentially, a sweater. It can transform into something new. Yet the weave is not there at first; it must be woven. Such degree of novelty and unpredictability justifies the need to organize the devices with the right balance between rigor and plasticity to allow for transformation.

The lines of a device “trace processes that are always out of balance… . Each line is broken, subject to changes in direction, bifurcating and forked, and subjected to derivations” (Deleuze, ibid., p. 338; author’s emphasis). Balance is always unstable. This description by Deleuze offers a very clear visual and conceptual representation of the intricacy and complexity of the itineraries of a device. Once constituted, notes Castro (2004), the device will be subject to a functional overdetermination process whereby positive or negative, wanted or unwanted effects will resonate or conflict with each other and demand a readjustment. Deleuze, in turn, states that “the first two dimensions of an apparatus or the ones that Foucault first extracted are the curves of visibility and the curves of utterance.” According to Foucault’s analysis, devices are like Roussel’s machines; “they are machines that make one see and talk” (Deleuze, 2007, p. 50).

Now, based on the notion of device, what does it mean to make someone see and talk in psychoanalysis? How do we situate ourselves as analysts? We are interested in Deleuze’s proposal because it allows us to view subjectivity as the effect of a weft that facilitates different modes of addressing conflict, symptoms, trauma, and mourning. It is worth recalling here the conclusion of one of Freud’s last lectures: “We cannot do justice to the characteristics of the mind by linear outlines like those in a drawing or in primitive painting, but rather by areas of color melting into one another as they are presented by modern artists” (Freud, 1933, p. 79).

Hospitality of the psychoanalytic device

Inspired by Derrida, A. M. Fernández describes two aspects of “the hospitality of the psychoanalytic device.” One has to do with the need to maintain unique modes of approach. The other, to the need to inquire into the analyst’s engagement in each case, that is, “the ongoing questioning of naturalizations or concealments of the patient’s way to approach life, gender positioning, sex choice, age group, and so on” (Fernández et al. 2014, p. 23), which are closely tied to socio-historic conditions. In keeping with these formulations, we view clinical devices as complex montages, joint constructions produced by analyst and patient where the link is what brings to light the various configurations of the device. In other words, the device is a product of the analytic link in the transference that, unlike the setting, does not precede it (Mauer, Moscona, and Resnizky, 2002).

It is our contention that each device is built jointly and collaboratively. It is not preconfigured, nor is it fixed; it can vary depending on immanent rules. The key to its validation lies in the a posteriori reading of its effects. The device, then, is a creation “by two or more than two” that facilitates the emergence of unprecedented possibilities. The lines of subjectivation, to return to Foucault’s term, would be those that ensure movement and openness; they oppose the idea of immobility. A line of subjectivation “is a process of individuation that … eludes both established lines of force and constituted knowledge. It is a kind of surplus value” (Deleuze, 2007, p. 341). This diverse configuration of subjectivity is akin to Foucault’s view of subjectivity as perpetually being constituted, a process whose outcome is the opening of a space where to reflect on an art of living (Castro, 2004).

Cartographies of the psychoanalytic field

Clinical devices, then, may be viewed as instruments at the analyst’s disposal within a framework configured by pacts and agreements whose terms have been jointly defined by patient and analyst. These devices foster the conditions for symbol formation and subjectivation that promote the unfolding of the analytic situation.

Complexity is characterized by ongoing transformation. Its greatest feature is its openness to the creation of a “custom-made” strategy. Thanks to self-organizing processes, each device sets its own course, defines its goals, and transcends the reductions caused by fragmentation. The purpose is to listen to human suffering. According to Freud,

We are threatened with suffering from three directions: from our own body, which … cannot do without pain and anxiety as warning signals; from the external world, which may rage against us with overwhelming and merciless forces of destruction; and finally from our relations to other men. The suffering which comes from this last source is perhaps more painful to us than any other.

(Freud, 1930, p. 77)

Expanded devices, which result from multidisciplinary and interdisciplinary approaches, have not erased the specificities of psychoanalytic practice. Rather, they have greatly expanded its scope.

As Foucault has said so well, claims Deleuze, “untangling the lines of an apparatus means, in each case, preparing a map, a cartography, a survey of unexplored lands” (Deleuze, 2007, pp. 338–339). This is what he calls “field work.” Nothing could be more akin to psychoanalytic practice than the need to develop with each patient a custom-made device – tailler sur mesure. Alert to the suffering of those seeking analysis, we are ready to develop a cartography, to trace the outline of the device along with them.

“One has to be positioned on the lines themselves,” adds Deleuze, “and these lines do not merely compose an apparatus but pass through it” (Deleuze, 2007, p. 339). “We belong to these apparatuses and act in them,” he states later on. The currency of an apparatus is its newness, and history “is the archive, the design of what we are and cease being while the current is the sketch of what we will become” (Deleuze, ibid., p. 345). It is not about “predicting, but [about] being attentive to the unknown knocking at the door” (Deleuze, ibid., p. 346).

It should be noted that what appeals to us about the notion of device is the diversity of its components and the relationships among them. Psychoanalytic institutions and our ways of belonging to them – commitment to transmission, our continuing professional development, writing, conferences – all are part of the psychoanalytic device and form the network that constitutes it. We are not extrapolating from philosophy but finding a different way of looking at our field. The texture, elasticity, and consistency of a device feed on the creativity of a group. A variety of combinations can be generated that, paraphrasing Foucault, present not only lines of subjectivation but also lines of fissure and fracture. The rules governing devices are situational. The rule consists in creating the rule.

Stretches and/or modules of the web

If devices vary, if their effects are examined after the fact, we are faced with a temporality that differs from that of the process – with a temporality of stretches. It becomes necessary, therefore, to distinguish between two notions. From the perspective of process, the stretch is a segment that is part of a straight line, a line that is configured as part of a totality. A process comprises logical moments. There exists, therefore, a continuous sequence because by definition, process means that everything changes except for the condition that enables everything to change. In a process, successive moments are gradually woven into a sequence that has a beginning and an end. The Hegelian concepts of fundamental continuity, linear time, and single meaning allude to this notion.

Yet progression can also be thought in terms of modules, of units that make up a weft. Thinking in terms of modules entails an epistemological break with the idea of continuity. Each module has intrinsic production value; each contributes to the construction of the device. It is thus evident that the ideas of a module-weft and of the construction of the device interact harmoniously. The multiplication of devices is simultaneous with the increased complexity of reading tools and of the skills needed to interpret each module. Switching devices makes it possible to access opaque or mute zones that could not be perceived otherwise. At this stage it becomes necessary to distinguish between setting and device.

Setting and device: differences

The notion of device differs, therefore, from Bleger’s classic definition of setting as a set of “constants within the framework of which the process takes place” (Bleger, 2013, p. 228).² In his book Fundamentals of Psychoanalytic Technique, Etchegoyen defines it as...

Table of contents

• Cover
• Half Title
• Series
• Title
• Copyright
• Dedication
• Contents
• Acknowledgments
• Permissions acknowledgments
• Series editor’s foreword
• Foreword
• Prologue
• Introduction
• Part I Couples and families today
• Part II Facing clinical challenges
• Bibliography
• Index