Psychoanalysis Comparable and Incomparable

The Evolution of a Method to Describe and Compare Psychoanalytic Approaches

David Tuckett

• Publisher: Routledge
• Year: 2008
• eBook ISBN: 9781134057719
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

How do we know when what is happening between two people should be called psychoanalysis? What is a psychoanalytic process and how do we know when one is taking place?

Psychoanalysis Comparable and Incomparable describes the rationale and ongoing development of a six year programme of highly original meetings conducted by the European Psychoanalytic Federation Working Party on Comparative Clinical Methods. The project comprises over seventy cases discussed by more than five hundred experienced psychoanalysts over the course of sixty workshops.

Authored by a group of leading European psychoanalysts, this book explores ways for psychoanalysts using different approaches to learn from each other when they present their work to fellow psychoanalysts, and provides tools for the individual practitioner to examine and improve his or her own approach. As described in detail in its pages, sticking to the task led to some surprising experiences, raising fundamental questions about the way clinical discussion and supervision are conducted in psychoanalysis.

Well known by many in the psychoanalytic community and the object of much interest and debate, this project is described by those who have had the closest contact with it and will satisfy a widely held curiosity in psychoanalysts and psychotherapists throughout the world.

David Tuckett is winner of the 2007 Sigourney Award.

1
On difference, discussing differences and comparison
An introduction

David Tuckett (UK)

• How do we know when what is happening between two people should be called psychoanalysis?
• What is a psychoanalytic process?
• How do we know when one is taking place?

Recognizing difference provides scope for thought. Comparison aids reflection. Difference, differentiation and comparison allow articulated thought and are at the heart of much creative development in many fields. But difference is also a potential fault line at the heart of the human psyche—and one along which prejudice, stigma, projection and xenocidal impulses can flow.

This book is about developing ways to describe and compare different methods of practising as a psychoanalyst. The aspiration behind the project is to develop ways of learning from each other, and to provide tools for individual practitioners to examine and improve their own approach. As we will be describing, this task has led us to some surprising experiences and has raised fundamental questions about the way clinical discussion and supervision are conducted in psychoanalysis.

This chapter will describe the background to the project’s inception, the early enthusiasm, the somewhat unexpected emotional and conceptual difficulties we encountered, and the outlines of the way we came to approach them. Each of the subsequent chapters will add details and further reflection, with a final chapter looking at wider uses of the method of clinical discussion that eventually evolved. We will argue that although psychoanalysis is unique and, therefore, incomparable, methods of practising can usefully be compared.

The growth of pluralism and its difficulties

Different conceptions of the psychoanalytic project have existed since its beginning (see, for example, Bergmann, 2004). Before now, however, these differences have not provided the basis for a creative and sustained process of elaboration, in which the common ground of psychoanalysis has become deeper, more secure or consensual.

In Freud’s lifetime, differences over technique and practice were largely held in check by the use of his authority to silence dissent (Bergmann, 2004; see also Tuckett, 2000). The tendency to invoke Freud as a silencing authority persisted even after his death, while individual psychoanalysts were similarly able to command authority in particular geographical or social contexts. In such contexts, deviants were controlled by a significant element of self-censorship, actual censorship and, in the last resort, by exclusion. Divergent individuals and their ideas could be and were deprived of influential positions in professional organizations or they were expelled completely. Others just walked out, together with key followers, before starting their own training institutions—a tendency shared by ‘scientific’ journals, meaning that there have been an increasing number of them over the years. Such methods of ‘resolving’ differences (i.e. by isolating and removing deviance) have been highly problematic—with a tendency at times for orthodoxy to enjoy an ‘intellectual reign of terror’ (Cooper, 2003).

All psychoanalytic groups have experienced charismatic authority, with the problem intensified by the integral role of training analyses, which have inevitable emotional and social consequences within societal life. Some groups were more affected than others and some developed ways of institutionalizing differences within subgroups rather than removing them to different groups (see, for example, King and Steiner, 1991). Nonetheless, insofar as it existed, the reign of terror is now largely over, and the imposition of orthodoxy by authority has failed. This can, at least partially, be explained by anti-authoritarian changes in cultural and political ideology in the latter part of the twentieth century. It may also follow from the fact that psychoanalysts in many places find a faltering demand for their services, as well as a declining supply of trainees, thus forcing them to work in more innovative ways (see, for example, Ahmed, 1994; Allison, 2000; Jaffe and Pulver, 1978; Rothstein, 1992; Wurmser, 1989, 1994). Most groups now have a wide range of different ways of practising within their membership.

It has seemed to me that to survive and to compete, adjustments have been made, for example in the criteria for analysability (now encompassing the more ‘difficult’ patient), and in the demands psychoanalysis has made on both the patient’s and the analyst’s time. Psychoanalysis has tried to become less elitist and more friendly, as well as less medical—whether these changes developed as a result of innovation within established societies moving towards a less authoritarian stance, or through the development of new ideas by those once excluded by but now embraced in new institutions. A further factor has been the greater accessibility of analysts’ own analysis for critical discussion and appraisal.

From the beginning of the discipline, training analyses have left a residue of unconscious ambivalent feelings about the process, including a lack of conviction about its efficacy, prompting both conscious doubt and unconscious hostility, the latter evident not so much directly but through observable defences such as the idealization or denigration of institutions, analytic methods and colleagues (see, for example, Bergmann, 2004; Kernberg, 1986, 1993, 2006, 2007). Such residues have also sparked changes—be they progressive or regressive.

The main argument in this book is that in the absence of open discussion about differences in psychoanalytic technique, the debate about opposing ideas and practices has been very difficult to maintain—with what I consider many negative consequences for psychoanalysis’ creative development as a secure and specific discipline. The usual way of proceeding in academia is by the critical scrutiny and debate of new approaches and ideas, leading to a consensus about the evidence for and usefulness of a particular argument. In the field of psychoanalysis, however, this approach has mostly been eschewed on account of the unease and dissatisfaction that many psychoanalysts seem to feel about the value of using evidence from their consulting rooms to support points to each other.

On the one hand, most reports of psychoanalytic sessions are thought of as inadequate to convey the subtlety of the unique experience of human individuality. On the other hand, they are dismissed as flawed because they are too subjective to ‘prove’ anything. In short, the task of convincingly conveying ways of understanding one person’s unconscious to another person has been considered too great for many to undertake. As a result, empirical study in psychoanalysis has often been overwhelmed by attempts to impose authority through theoretical and oratorical rhetoric—despite Freud’s undoubted commitment to some form of ‘facts’. Paul Denis discusses this at greater length in Chapter 2.

A consequence of the reliance on authority and exclusion is that psychoanalytic differences have tended to become politicized as well as personalized, something that Chapter 2 also demonstrates. Since about 1970 (and particularly in North and South America) this has to me seemed rather clear: struggles over differences in theory, practice and transmission have largely become the history of politics and personalities (see, for example, Richards (2003) and the following commentaries). As mentioned, the context of psychoanalytic politics has altered so that the capacity to impose authority seems to have become greatly weakened in recent times. However, one of the untoward consequences of this has been a plethora of ideas and techniques described in different languages, often using the same concepts to describe entirely different ideas (see, for example, Canestri, 2002; Hinz, 2002; Spillius, 2002).

It must be granted that a clear formulation of psychoanalytic ideas is inherently difficult. Concepts are elastic and practice is implicit (Sandler, 1983). Moreover, the discipline deals with subjective experience beyond consciousness and reason. At its heart it is and must be individualistic, emotional and highly personal. The unconscious processes codified by Freud are condensation, displacement and absence of contradiction. They involve symmetrical (rather than Aristotelian) logic—in which ordinarily divergent propositions are equally true, space is multi-dimensional and time is bi-directional or even ‘shattered’ (Faimberg, 2005; Green, 2000; Matte Blanco, 1988). Practice necessarily involves sensibility and intuition as well as cognition.

To add to all this, psychoanalytic data are hard to transmit between persons. ‘Misunderstandings between psychoanalysts from different schools or different countries are not common—they are the norm’, writes Denis in Chapter 2 (p. 38). Fundamental to psychoanalysis is that understanding is inherently personal and emotional, dependent on the feelings and phantasies that a particular set of ideas or practices evoke in the subject, and many of which influence comprehension in ways of which the subject is not conscious. This is one reason why the transmission of psychoanalysis from one generation to another has not been easy; insofar as there is a gap between experience and theory, this is especially true in the area of technique. Further exacerbating this gap between experience and theory is the tendency for such lacunae to have been filled using ‘authority’ and ‘deference’—perhaps leading to an unconscious, sadomasochistic and unnecessary submission to said authority, and to the unstable and ambivalent relationship to knowledge and teachers that such a submission would imply.

Since the early 1980s, it has seemed to me that the difficulties in transmitting psychoanalysis have accumulated, becoming fused with the problems of evaluating individual differences in practice. Together with the various efforts to treat more disturbed patients, these trends have led to gradual but significant shifts in views about what psychoanalysis ‘really’ is about, as well as many alterations in the understood meaning of important concepts. A situation has arisen whereby there are multiple viewpoints concerning both the practice and the theory of psychoanalysis, and it this multiplicity that we term as ‘pluralism’.¹

It has also seemed to me inevitable that once pluralism was finally accepted—as it needed to be—the pace of ‘pluralistic’ tolerance of new and varied approaches would accelerate. Nothing really exists to contain or discipline it. In fact, the pace of change that has characterized the period since the early 1980s has been so rapid that it is now seriously difficult to know what does and does not constitute psychoanalytic work, and so it is difficult to distinguish when it is being practised creatively and competently.

Moreover, to the extent that this is an accurate observation, significant difficulties within the profession are compounded at the interface with other professions. In the absence of operational clarity, it is inevitable that boundary relationships with psychoanalytical psychotherapy have become marred either by confusion or by the arbitrary politics of exclusion. If there is no reliable and definitive difference in definition and practice between psychoanalysis and psychoanalytical psychotherapy, then boundaries inevitably get determined by bureaucratic decisions with potentially harmful consequences to all.

Throughout the course of this book many accounts will support the idea of a very wide range of contradictory practices calling themselves ‘psychoanalysis’, as well as much confusion in current psychoanalytic theory and technique—particularly at the level of its specific implementation. Such confusion may be highlighted for the reader if he or she takes a moment to consider the challenge of trying to give clear exemplified answers to questions like the following:

• What is a psychoanalytic interpretation and when and for what purpose can it be said to be a transference interpretation?
• Is all practice by a psychoanalyst psychoanalysis? What is the difference between psychoanalysis and psychotherapy—especially if practised by the same person?
• What does it mean when a psychoanalyst advocates attending to a patient’s unconscious and (if we describe it in traditional terms) how exactly can we recognize when free association and free-floating attention are taking place?
• When and for what purpose might an analyst ‘construct’ hitherto unconscious traces of a patient’s history or infantile sexual wishes and phantasies; how does the analyst know when such wishes and phantasies are there?
• What is the meaning and value in the clinical situation of recognizing or not such phenomena as transference, resistance, empathy, psychic conflict, etc?
• Most crucially: how does psychoanalysis ‘work’ and for whom? And, if it does work, do some ways of ‘working’ ‘work’ better than others?

Beginning a Pan-European Project to compare differences

The evolution of a method to explore and compare differences in psychoanalytic work, which will be described in the chapters of this book, is not intended to answer the above questions in a definitive way. Rather, we will explain how we tried to find a psychoanalytic method that allowed us to make secure comparisons, with the eventual aim being to generate a clear and comparable description of the range of answers that different psychoanalysts might give to the above questions—focusing not on abstract ‘official’ answers, but on examples from their practice. The context in which we have tried to do this follows on from the idea of inviting European (and later North and South American) psychoanalysts to meet at annual workshops and to try to see if they could describe and compare their work more rigorously than hitherto. It started, therefore, from the wish to be empirical: to base our study on experience of descriptions of analytic work.

The project began with what had seemed a simple strategy: to mobilize European colleagues to become interested in tackling the problems just mentioned and to create the conditions in which they could do so in an ongoing way.² What we did one year would be reflected on during the succeeding months and then be fed back into the plan for the following year—and so on for several years. (A ten-year initiative was agreed, as a further part of the institutional structure: see Appendix.) The project as a whole had four aims:

• To increase the possibility for all of us to reflect on what we were doing and to learn from each other and to debate with each other much more precisely.
• To identify when we thought two colleagues were or were not, in their detailed practice, using the same or a different psychoanalytic method.
• To give us the future possibility of recognizing the competence of a candidate or a colleague who aspires to use a particular psychoanalytic method.
• To recognize a pseudo-application of any particular psychoanalytic method/model.

A preliminary meeting involving some of the analysts most closely involved in the project took place in Brussels three months before the first workshops. (Further details of this meeting are in the Appendix.) The idea was to try to anticipate some of the issues that we would face in these workshops, which were to be the core setting for exploring the different ways in which psychoanalysts work. It was also our intention in Brussels to test the usefulness of the proposed strategy of workshops followed by working party reflection on the work, followed by more workshops, and so on.

The workshops would be held at the annual European Psychoanalytic Federation (EPF) Conference, which brings together experienced psychoanalysts from more than twenty societies working in twenty or so languages. The first took place in Prague in 2002, followed by Sorrento in 2003, Helsinki in 2004, Vilamoura in 2005, Athens in 2006 and Barcelona in 2007—although this chapter will concentrate almost exclusively on the work done in Prague, Sorrento and Helsinki.

In Prague, 120 clinicians from about twenty countries were divided up as evenly as possible and invited to sit in small groups of twelve. Each group listened to a clinical presentation from two colleagues apparently working in different psychoanalytic cultures. The workshop sessions lasted for five or six hours, and towards the end the group would try to compare the two analysts’ methods of working.

The presenting analysts for these workshop groups were chosen via recommendations. They were to be colleagues thought of as gifted clinicians (rather than theorists or society leaders) based on word-of-mouth reputation in their society. The cases they were to present should be from a treatment that the clinician defined as ‘a’ psychoanalysis.

To maximize the range of viewpoints in each group, workshops were in English and, in a few cases, French. Each group would have at least one bilingual person to moderate the discussion, and members of the groups were all asked to adhere to the defined task: to make the assumption that the colleague presenting in their workshop was a psychoanalyst with an established way of working and to use the time to try to describe what this way of working was—with a view to comparing the essentials of the work of the two presenting analysts.

Enthusiasm and excitement were an immediate response both at the preliminary meeting and at the workshops themselves; it was felt that, however ill-defined, something novel was happening. In the preliminary meeting in Brussels and then in the first two workshops in Prague and Sorrento (see Chapters 3 and 4), the vast majority of participants became enthusiastically committed to the project, and in many cases—including my own—felt they had participated in a new and rich kind of clinical meeting. I think this success was largely attributable to the very high quality of thinking by those who accepted their invitations, as well as to the enjoyment gained from taking in-depth clinical material seriously and from hearing other experienced and thoughtful colleagues reflect on it. Significantly, the time allocated for discussion was longer than usual.³ Furthermore, thanks to the range of experienced colleagues...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• List of illustrations
• About the authors
• Acknowledgements
• Time chart
• Introductory foreword
• 1 On difference, discussing differences and comparison: an introduction
• 2 In praise of empiricism
• 3 Before the method, underestimating the problem and the meeting in Prague
• 4 The Sorrento experience: chaos replaced by too much structure
• 5 Some reflections on the problems of comparison and difference in the light of doubts and enthusiasm
• 6 Reflection and evolution: developing the two-step method
• 7 Work in progress: using the two-step method
• 8 Experiences of participating: group processes and group dynamics
• 9 Some surprises: a new style for case discussion?
• 10 Reflection and comparison: some final remarks
• Appendix: the origins of the EPF ‘new’ scientific policy and the early history of the working party
• References