Part 1
On the analytic relationship
Deborah L. Browning
One can discern two interrelated themes running through Schimekâs chapters on the analytic relationship. The first is an assumption of asymmetry in the analytic situation and the implications this has for issues related to the enactment of interpersonal power. The second and closely related theme concerns the extent to which the analyst brings her own frame of reference into her listening to the patient. With these two issues in mind, Schimek steps back from the clinical situation and discusses somewhat broadly the topics of transference, countertransference, psychic reality, intersubjectivity, enactment, and therapeutic action. The protagonists in this story of the analytic relationship are Freud, Klein, Winnicott, Schafer, Loewald, Gill, Hoffman, Renik, Ogden, and the Sandlers, whose ideas he uses to clarify the conceptual and theoretical points he wants to make.
Schimek also moves forward to share his stance with respect to his own work as a clinical psychoanalyst and how he thinks it fits within the field as it exists today. I will limit my notes, here, to highlighting Schimekâs concern with the asymmetry and power differential in the analytic situation and the way in which the analystâs conscious categories of interpretation and unconscious psychic reality risk taking center stage. Following these comments, I will provide a brief synopsis of each chapter.
POWER AND THE PATIENTâS POINT OF VIEW
Simplifying the history of psychoanalysis rather greatly, one may note that when Freud found that suggestion was insufficient for his purposes, he began to exert pressure. That failing, a struggle broke out between analyst and patient. It was as if the analyst now had a mandate to overpower the patientâs mindâand, by extension, her self. (It is called âbreaking through resistance.â) Today, as medical practice outside the institute has been increasingly required to collaborate with a patient in all aspects of her care, the psychoanalyst is left with the thorny task of figuring out how to be of help and use, without taking over, without misusing the power that the pained and paying patient will likely be inclined to offer.
At the close of his âDynamics of the Transferenceâ (1912), Freud remarked that âthis struggle between the doctor and the patient, between intellect and instinctual life, between understanding and seeking to act, is played out almost exclusively in the phenomena of transference. It is on that field that the victory must be wonâ (p. 108). Freud was an ineffectual hypnotist, and his forays into the pressure technique failed to yield his hopedfor discoveries of the patientâs âhidden and forgotten erotic impulses.â It now appeared to him that transference would be a new âroyal road.â
But what, exactly, is transference? If we think along with one of Freudâs criteria of transference as that which is âinappropriate,â then one may raise the questions: âinappropriate in what respect?â, âinappropriate according to whom?â Schimek suggests rather provocatively that perhaps there is no such thing as transference, only transference interpretations. He points out that different analysts will identify different aspects of the patientâs behavior and affect as transference, contingent upon their own frame of reference, beliefs about the purpose of treatment, and personal defensive needs, so that the nature of this victory that Freud would have us win risks becoming the victory of the therapistâs point of view over that of the patient.
Schimek assumes that the analytic situation is unavoidably asymmetrical and involves an imbalance of power, but this need not and must not mean that the analyst becomes the final authority on what is true. Even the new perspective that the analyst may hope to provide is not meant to supplant or supersede the patientâs, but rather only to enlarge and supplement it. And while he agrees with much that Gill and Hoffman bring to our attention about the influence of the analyst on the patientâs experience, Schimek believes that, because the analyst must restrain the revelation of his own private associations in order to protect the patient from undue influence, a ânegotiated consensusâ about what is actually happening in the interpersonal situation, is most likely an unreachable goal. Schimek suggests that recognition of the asymmetry places particular responsibility on the analyst for self-control, self-discipline, and tolerance of frustration. The rule of abstinence applies as much, if not more, to the analyst as to the analysand. This restraint is all in the service of the analystâs efforts to be an attentive, alert, open-minded listener. It is the patientâs point of view that should take precedence, and it is the analystâs task to safeguard this view.
Of what are patient and analyst together in search? Schimek takes a traditional point of view that the goal of analysis should be greater selfawareness and self-knowledge and that the role of the patientâs reconstruction of her history is crucial. This construction and reconstruction of the patientâs life story, while pursued together, must make some kind of intrinsic sense to the patient. The patient must be allowed to assume first and final authorship in filling out a story where, initially, there may have been only inarticulate and fragmentary elements.
In taking this position, Schimek indicates his view that a personâs past is not buried exactly as it once happened, providing clear, veridical memories. The past will have left its imprint, to be sure, but not necessarily in a way that can be remembered in a singular, distinct, and accurate way. And it is this assumption of a real and influential, but largely unrememberable, early past that makes it all the more important that the patient should be the âfirst authorâ of her story. This role of first author both respects and supports the patientâs sense of identity and self-image, and her way of relating to the world. The understandable urge of many therapists to move in, take over, and fill in the gaps, imposing their own assumptions demands what Schimek refers to as the rule of abstinence for the analyst.
While Schimek perhaps privileges the importance of historical construction and reconstruction in the analytic process, he does not dismiss the significance or the reality of the analytic relationship, even if mostly mediated though the interpretive activity of the analyst. His thinking at times is reminiscent of Loewald, and he sees the analytic situation as a staging area where prior relationships are lived out under the stewardship of the analyst as âstage director.â What may account for therapeutic change is not so much a new view of the past, but more likely the internalization of the patientâs experience of the relationship with the analyst. And, here again, we see the ascendance of the patientâs point of view, in that what matters and is potentially internalized is the patientâs explicit, as well as unexpressed, opinion of what in that relationship constituted âtransferenceâ and what for him or her has been real.
PSYCHIC REALITY AND THE MIND OF THE ANALYST
Discussions of the analytic relationship in clinical psychoanalysis involve issues related to reality and fantasy, self and other, past and present, psychical and external reality. We assume increasingly that these ideas and phenomena cannot be dichotomized, nor should they be polarized; rather each âthis and thatâ is a blend, an âinterpenetrating mix-upâ (Balint, 1960, p. 39), that can only be worked with, handled, transformed, detoxified, but most likely never fully disentangled. The âtruthâ of a situation can never be fully known. The concept of psychic reality is particularly useful for its emphasis on something ineffable about the patientâand also the analystâthat, while ultimately unknowable, still requires our full attention. It captures both âinflicted fact and purposeful editingâ (Friedman, 1995, p. 27). It is that which gives shape to the neurosis, to fantasy, dreams, slips of the tongue, to the analystâs desire to know, and to the patientâs resistance to knowing. In its timelessness, it plays tricks on us, inspires our multiple self states, makes us feel restless during those moments when time seems to stand still.
Definitions of psychic reality abound, and while the concept is made use of in a great many psychoanalytic articles, there remains no consensus as to its meaningâonly choices of definitions. In his recent discussion of the topic, Zepf (2006) takes the position that the idea of psychic reality should not be âwatered downâ from Freudâs original conception. Freud introduces the term psychical reality in the closing pages of the seventh chapter of The Interpretation of Dreams (1900), writing:
The unconscious is the true psychical reality; in its innermost nature it is as much unknown to us as the reality of the external world, and it is as incompletely presented by the data of consciousness as is the external world by the communications of our sense organs. (p. 613)
But this comment is sufficiently ambiguous, and there are few enough other elaborations by Freud that there is still leeway for interpretation of its meaning.
Schimek defines psychic reality first by that which he views it is not. It does not refer to a patientâs conscious, subjective experiences. At most, these experiences would reflect, be derivatives of, be shaped by something underlying. Schimek reads Freudâs comments on psychic reality to suggest âthat unconscious wishes have an autonomous structure, organization, and persistence with an enactive power and causal efficacy of their ownâ (see Chapter 3). He is thus describing psychic reality essentially as unconscious fantasy, a topic he elaborates extensively in Chapters 9 and 10 on unconscious mental representation and fantasy. As such, Schimek defines a personâs psychic reality as consisting of a set of basic, unconscious fantasies that operate in the manner of Kantian categories to organize, structure, and give meaning to experience.
In the chapters on the analytic relationship, Schimek emphasizes the way in which the analystâs own psychic reality as well as her assumptions of certain basic, organizing fantasies in all individualsâ psyches can influence both listening to and speaking with the patient. Schimek argues that, to the extent that psychic reality involves a âlimited set of primary fantasiesâ that organize and give meaning to oneâs experience, the analystâs choice of interpretive category, whether it is that of the âholding mother,â âthe oedipal father,â or âthe mirroring parent,â reflects an aspect of her own psychic reality taking shape in her theory of mind, which can be imposed upon the patientâs material.
Schimek compares the analyst at work, making meaning while listening, with Freud, the âarcheologist of the mind,â and suggests that, in both cases, this reflects a basic search by the individual for causes and explanations. And it is these theories and the material that gives content to them that constitute an individually created psychic reality. Put another way, our psychic reality is constituted because of our need for causes and explanations, which operates, then, as much in the analyst as in the patient. While not linking it specifically to psychic reality, Blass (2006) elaborated extensively on this desire for knowledge in her paper on Freudâs (1910) âLeonardoâ monograph. One will see the topic of psychical reality taken up more fully by Schimek in his considerations of Freudâs seduction theory (Chapters 7 and 8).
Not only will the analyst bring her own personal history, implicit theory of development, psychopathology, goals of treatment, and âvoicesâ of prior supervisors (Smith, 2001) into the psychoanalytic situation, but each theory of psychopathology, development, and therapeutic change also has built into it assumptions about the presumed psychic reality of the patient. It is this issue about psychic reality at its broadest level that Schimek brings into his thinking throughout the chapters on the analytic relationship. These differing psychoanalytic models of a prototypical past tag along with the analyst in her listening, regardless of whether the material is about the patientâs past, current life, or expressed in the here and now of the analytic situation.
Despite the imbalance in the analytic relationship and the vulnerability of many patients toward interpersonal submission, how might we try to limit the imposition of our own frame of reference on the patient? How do we limit the rigidity of our assumptions about what we see or what we expect to see in any next moment? In her extensive writing on analytic listening, Schwaber captures Schimekâs advocacy of the patientâs point of view when she refers to the âinherent legitimacyâ of the patientâs experience. She writes:
We lose sight of the fact that our vantage point, even our view of ourselves, is simply thatâours; the patient may have another, the inherent legitimacy of which is still to be found. We tend, thereby, not to ask, not to take our patients at their word. (2006, p. 17)
Schwaberâs writing on analytic listening helps attune the analyst to the possibility that, by carefully following the manifest, the conscious in the patientâs thinking and feeling, more unconscious areas will be opened up, and the analyst will be less inclined to impose âassumptionsâ about the unconscious on the other person.
Pineâs (2006) recent plea for a measure of diversity and tolerance thereof offers a different kind of anodyne for the pain of the dissonance between the patientâs experience and the analystâs frame of mind. To the extent that we open ourselves to a âmultiplicity of ideas about mindâ (p. 464) and accept and recognize their intrinsic validity in certain contexts with certain patients, we open ourselves as well to the differing needs of different patients and also, importantly, to the shifting needs of any individual patient at any given moment. In doing so, we offer ourselves, and thus our patient as well, more opportunity to find and employ, if only initially and preconsciously, the least discordant conception until the individuality and originality of the patient and her experience is more fully understood.
CHAPTER SUMMARIES
In Chapter 1, âPsychoanalysis and Transference: Yesterday, Today, and Tomorrow,â Schimek reminds the reader that clinical psychoanalysis was never Freudâs primary motive or goal and that his writing on technique comprises a fairly small proportion of his total work. He points to the way in which psychoanalysis has become increasingly concerned with treatment issues in the last 40 years and has been applied in ever greater variation to an ever broader range of patients in ever lengthening analyses.
In Chapter 2, âThe Construction of the Transference: The Relativity of the âHere and Nowâ and the âThere and Then,ââ after providing a succinct summary of Freudâs criteria of transference as inappropriateness, resistance, and repetition, Schimek proceeds to challenge many aspects of the concept and the phenomena that are labeled as such. He points to the extent to which transference is defined by the analyst in terms of her view of pathology, development, and goals for the treatment. Those aspects of the transference that will serve to facilitate the treatment may well be ignored, allowed to flourish in a sotto voce manner, or relabeled as the âreal relationship.â He considers the writing and theories of Melanie Klein and Gill and Hoffman in order to show that, in two such different approaches to treatment, both work within implicit models, leading to selective constructions influenced by the analystâs frame of reference.
In Chapter 3, âIntersubjectivity and the Analytic Relationship,â Schimek discusses Renikâs oversimplified caricature of the objective, neutral, anonymous analyst. He points to the pitfalls of the postmodern emphasis on relativity and the idea that an analytic relationship could ever truly be a âcollaboration between peersââunless, perhaps he comments wryly, the individuals took turns paying each other. In his discussion of Ogden, Schimek notes the many ways the idea of projective identification is used, and he questions the assumption that unconscious influence seems to be assumed to be unidirectional, from patient to analyst, and that the analyst could truly function as a âclean containerâ without the mediating effect of his own psychic reality.
In Chapter 4, âOn the Resolution of the Positive Transference: Suggestion, Identification, and Action,â Schimek returns to the topic of transference per se, focusing here on the role and fate of the positive transference and the idea that, more than just identifying with the analyst or his interpretations, internalization of the entire relationship with the analyst may be a crucial part of therapeutic action. He also elaborates on the importance of interweaving the patientâs experiences from the three different perspectivesâof her experience of her past, her experience of her ongoing life, and her experience of the analytic situationâin providing a part of the therapeutic action.
In Chapter 5, âTransference and Psychic Reality: Ideas About the Timeless Past in Psychoanalysis,â Schimek explores the concept of psychic reality, extends this discussion to a consideration of the impact of the analystâs psychic reality on the analytic process, and concludes with an emphasis on the centrality of the concept of psychic reality in psychoanalysis.
In Chapter 6, âFurther Thoughts on the Contemporary Analytic Relationship,â Schimek summarizes what he sees as six interacting trends found within discussions of the contemporary analytic relationship. He considers issues related to countertransference and enactment, and he proposes his own view of the principles and goals of the analytic relationship.
Chapter 1
Psychoanalysis and transference
Yesterday, today, and tomorrow*
It is well known that Freud never saw himself primarily as a therapist and healer; neither did he view psychoanalysis as first and foremost a technique of therapy, nor even a theory of psychopathology. In the most general way, he defined psychoanalysis as primarily a procedure for the investigation of mental processes which are almost inaccessible in any way other than from the special analytic situation. Only secondarily was it defined as a method for the treatment of neurotic disorders based on that investigation. Thirdly, psychoanalysis was a collection of psychological information, gradually being accumulated into a new scientific discipline.
In 1926 Freud stated that âthe future will probably attribute far greater importance to psychoanalysis as the science of the unconscious than as a therapeutic procedureâ (1926b, p. 265). We may now see that this was more a wish than an accurate prediction. For Freud, psychoanalysis was âthe science of the unconscious mindâ (1923a, p. 252), a depth psychology. His major interest in psychopathology was that it should make a unique contribution to the understanding of normal mental functioning. He repeatedly stressed the continuum and basic similarity between neurotic and normal phenomena. From the beginning of his writing, he used data not only from the clinical situation, but also from dreams, slips of the tongue, jokes, folklore, and myths. His two major works, The Interpretations of Dreams (1900) and Three Essays on Sexuality (1905b), deal with the psychopathology of everyday life and are not meant to apply primarily to neurosis.
It is also well known that Freudâs writings on treatme...