Key Ideas for a Contemporary Psychoanalysis

Misrecognition and Recognition of the Unconscious

Andre Green, Andrew Weller

• Publisher: Routledge
• Year: 2012
• eBook ISBN: 9781135446963
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

André Green attempts the complex task of identifying and examining the key ideas for a contemporary psychoanalytic practice.

This undertaking is motivated both by the need for an outline of the evolution of psychoanalysis since Freud's death, and by the hope of tackling the fragmentation which has led to the current 'crisis of psychoanalysis'.

In three sections covering the theoretical and practical aspects of psychoanalysis, and analysing the current state of the field, André Green provides a stimulating overview of the principal concepts that have guided his work. Subjects covered include:

• Transference and countertransference
• Psychoanalysis and Psychotherapy: modalities and results
• Language-speech-discourse in psychoanalysis
• Recognition of the unconscious

This unique contemporary perspective on the psychoanalytic enterprise will fascinate all those with an interest in the problems that face the field and the opportunities for its future development.

PART ONE

Practice

1

THE WORK OF PSYCHOANALYSIS

No chapter of any general work on psychoanalysis has changed so much as that which concerns the psychoanalyst's praxis. And yet it remains surprising to read Freud's articles on technique (1904–1918, with the exception of the writings of 1937) which still have a certain contemporary relevance. Up until about the 1950s, psychoanalysis seemed to be quite a homogeneous discipline, with an indisputable identity, its purpose being psychoanalytic treatment stricto senso. The parameters of the latter could vary somewhat occasionally, but they rested on a set of propositions shared by all psychoanalysts. At the time, what was later called – depending on the country – orthodox classical psychoanalysis (United States) or the classical treatment (la cure type, France), constituted their activity almost exclusively. As time passed, the problems of the variations of technique were given consideration, but there was general agreement that psychoanalytic treatment remained the activity to which they devoted themselves. In recent years, the psychoanalytic field has been diversified by the progressive addition of derived techniques (group psychoanalysis, psycho-drama, etc.) or again of applications of psychoanalysis (with ad hoc technical modifications) to different types of patients (children or adolescents, psychotics, psychosomatic patients, psychopaths), often practised in specialized settings (community clinics or hospitals, psychiatric hospitals, prisons, etc.). To avoid encumbering my exposition, and despite the interest presented by these technical innovations, I will confine myself to speaking of a more circumscribed field. I have proposed that a distinction be made between the following:¹

1 The work of psychoanalysis: that which is carried out in the analyst's consulting room; it may be divided up into analysis properly speaking, analysis with temporary or permanent technical variations and, finally, a subject which deserves all our attention today, psychotherapies practised by psychoanalysts. I would add to this the centres of psychoanalysis or psychotherapy where an attempt is made to recreate, as far as possible, the conditions of private practice.

2 The work of the psychoanalyst: the work carried out by a psychoanalyst outside his consulting room, when he is part of an institution that is not exclusively devoted to psychoanalysis and psychotherapies, in which he collaborates with others by contributing his know-how and knowledge.

3 The work of the person psychoanalysed (le psychanalysé): this is the work of someone who, having undertaken an analysis, has not wished to become a psychoanalyst thereafter, but uses what has been acquired from this experience in his work which may be relatively far removed from psychoanalysis, or may even lie outside the therapeutic field.

I propose, then, to confine myself here to the work of psychoanalysis.

The classical treatment

While it is true that it no longer rules supreme in the activity of the psychoanalyst, it is no less true that the classical treatment remains for every psychoanalyst the indisputable reference for evaluating the kind of work to which he devotes himself. It is not because the necessities of practice oblige the psychoanalyst to take account of the limits of the application of his technique of reference that it is thereby relativised. It remains the yardstick with which other forms of therapy may be compared. How are we to understand the evolution which has led psychoanalysts to water down their wine and to give up a purism which ultimately lay in a stubbornness that was somewhat deadly? One can, of course, follow the literature chronologically with a view to detecting step by step the emerging facts which testified to a painful revision. It seems to me more interesting, as we look back, to ask ourselves what this transformation is due to.

Let us remember that Freud, from the beginning of his work, excluded the actual neuroses and the narcissistic neuroses from the field of application of psychoanalysis. The former suffered, in his opinion, from an insufficient elaboration of the libido which was discharged into the soma without involving any processes of symbolisation. The actual neuroses pleaded in favour of the absence of any real psychosexuality: in short, a libido discharging itself into the soma, which is quite different from a bodily libido undergoing conversion. As for the narcissistic neuroses, what they were lacking was the capacity of the libido to invest objects, apart from those of childhood, and its tendency to withdraw into the ego. One thinks of course of the process of turning away from reality that can so often be observed in psychotics. These formulations may appear old-fashioned today and too dependent on the ‘hydraulic’ model for which Freud has been reproached. In fact, if we think about it carefully, it is above all important to note Freud's concern to give a psychic treatment its maximum efficacy, as if he were trying to say that only what has undergone a process of ‘psychization’ can be treated psychically. This psychization manifests itself in two ways: on the one hand, by adopting a longer path than that which leads to somatization, the short path par excellence, and, on the other, by a capacity for mobilization enabling the subject to come out of himself and to leave behind his past fixations by investing new objects outside himself, a libidinal investment which brings sexuality into play and is capable of being displaced on to another person (this is transference: the primitive objects of childhood are replaced by projection on to the actual objects of the treatment). Freud was most probably interested in the neuroses because their structure was still the one, in the field of pathology, that was most reminiscent of the conditions of ordinary life. At the time, the main concern was to distinguish between neuroses and normality, even if Freud had already conceived of all the intermediaries existing between the normal state and the neurotic state. Certain privileged psychic structures formed a bridge between normal subjects and neurotics. Thus, acts of forgetting, slips of the tongue, bungled actions, in short, the entire psychopathology of everyday life, made it possible to understand normal subjects as neurotics without it being possible to make a clear separation between them. Furthermore, he did not hesitate to find in himself numerous traits belonging to neurosis. What is more, certain formations of the unconscious were common to the neuroses and normal people, for instance, dreams, phantasies, and even transference, which was scarcely confined to psychoanalysis. As psychoanalysis extended its interests, and as the patients who came to consult psychoanalysts began to fall somewhat outside the limits of the transference psychoneuroses, the discipline found itself faced with hitherto unknown difficulties. Not long after the 1920s, a great deal of activity was manifested by psychoanalysts who were concerned to improve results, which left something to be desired. This movement continued for a long time without anyone realizing that the difficulties encountered in the treatment stemmed from the fact that the categories of patients who were resorting to psychoanalysis fell outside the fairly strict framework defined by Freud. He had already paid a price for this himself in what was probably the most fascinating of the clinical cases he related, but also the greatest failure of psychoanalysis, namely, the Wolf Man. Freud was only interested in it from the standpoint of infantile neurosis, but it is considered by the majority of psychoanalysts today as a borderline case. One should mention here the inspirational work of Ferenczi, who mingled in a very surprising way technical aberrations, going beyond what is acceptable, with observations of great profundity which bear witness to his quality as a visionary and precursor of the entire field of contemporary analysis. However that may be, even if ‘Analysis Terminable and Interminable’ – Freud's testamentary text on the state of analysis on the eve of his death – gives a good idea of the problems encountered by analysis before the Second World War, it seems to me that it was above all around 1950 that a clear change occurred. The theories of Melanie Klein in England and those of Hartmann in the United States had doubtless already been developed, but it was certainly around this date that variations of technique began to be proposed.² Generally speaking, it was simply a question of improving the result of the psychoanalytic treatment by adopting more or less temporary appropriate methods, without modifying profoundly the guiding principles of transference, resistance and interpretation. It can be said that the authors were divided into two groups. In the first, they were content to commend such and such a variation without profoundly modifying the frame of reference. In the second, it was this very frame of reference that was modified – in Kleinian analysis, for instance, which proposed an altogether singular technique based on a theory which diverged considerably from Freud's. Thereafter, other major authors of psychoanalysis also proposed their conception of psychoanalysis, often calling into question the Freudian conception. It has to be said that there continued to be a marked change in the population of analysands. At a certain period, there was less and less talk of transference psychoneuroses and more and more of the new arrival in the field of psychoanalysis – character neurosis – even though it had been known about since Reich. A distinction was made between character neurosis and neurotic character, and the importance of pregenital fixations (Bouvet) was emphasized. The shift of emphasis on to the study of the ego was considered a good thing. The theoretical proliferation continued to manifest itself, each one hoping that his theory would be successful in resolving the practical problems in the face of which the theories of others had failed. I am skipping over many stages and avatars which, following psychoanalytic modes, place this or that concept in the limelight.

Psychotherapies practised by psychoanalysts

I will now turn to the present situation. One of the most important problems of contemporary clinical psychoanalysis concerns the psychotherapies. For a long time the psychotherapies were considered as a marginal activity, above all of practical interest (the famous brass in contrast with the pure gold) which could not lay claim to the same titles of nobility as psychoanalysis. The psychotherapies were above all designed for cases for which psychoanalysis seemed unable to give the desired results, on the basis of arguments which today appear highly debatable (weakness of the ego, strong pregenital fixation), and which called for an attitude that went beyond the usual neutrality. The psychoanalyst, for instance, would intervene actively by inviting the analysand to take such and such a decision, or even by injecting vigour into him in order to support his ego and to encourage him to get rid of his symptoms, or in a thousand other ways which did not have much to do with psychoanalysis. The psychotherapies took us back, whether we realized it or not, to the heyday of suggestion. I will not expand on the work of these courageous pioneers who accepted to take care of cases not considered ‘worthy’³ of analysis but which nonetheless required the help of analysts. Nevertheless, I am afraid that many illusions have been entertained about the empirical and pragmatic value of the technique in question, in the measure that the results obtained have been but transient, partial and without any deep modification. To be perfectly frank, I do not see how a result can be obtained short of an analysis as complete as possible of the unconscious conflict. I do recognize that such an analysis is very far from being easy, and that in many cases, it probably takes much more time than resolving a transference neurosis in a classical treatment. Still, this question of the psychotherapies did not arise from the resistance of certain patients to analysis, or from the scepticism of practitioners inadequately armed to deal with the difficulties of analytic treatment, but from the accumulation of disappointments which called for a thorough revision of received ideas. The problem of the psychotherapies rests on multiple findings which need to be distinguished. The indications for psychotherapy are:

1 People whose material situation or geographical location does not permit them to undertake a psychoanalysis. I shall not be considering these cases which involve material problems that are unrelated to considerations of the patient's analysability.

2 People for whom, manifestly, the depth, range and past history of the disorders is such that psychoanalysis cannot reasonably be envisaged. In certain cases where I have tried to carry out an analysis against my better judgement, I have observed a state of extreme disarray and deep distress which I have described under the name of syndrome of psychic desertification.⁴ What we have to learn from these cases is that the psychoanalytic setting is not only a technical condition of the possibility of analysis or even a theoretical–clinical concept, but that it is in fact an incomparable clinical diagnostic instrument.

3 In another category we can put those cases where one or several psychoanalytic treatments carried out according to the rules of the art have only led to a very partial alleviation of the symptoms, and where the persistence of certain unresolved conflicts continue to trouble the patient a great deal, making the continuation of analytic work necessary. In evaluating the number of psychotherapies practised by psychoanalysts, the portion which stem from the partial or unsatisfying results of one or several earlier analyses is greatly underestimated.

4 Finally, there are cases which present good indications for psychotherapy and which can usefully take over from the indications for classical treatment insofar as they constitute the sector that is immediately adjacent to them.

It is clear that the polymorphism of the population of patients who are in psychotherapy with psychoanalysts, and who do not wish to receive help from anyone but an analyst, constitutes an original population with whom authentic psychoanalytic work can sometimes be achieved. One can conclude that there is a new necessity in psychoanalytic training for psychoanalysts to learn how to practise psychotherapy. If one fears amalgams with other psychotherapies and the loss of specificity which might ensue for the work carried out by psychoanalysts, other descriptive labels could be proposed which point up both the difference from classical treatment while, at the same time, linking these techniques to psychoanalysis. One suggestion has been ‘psychoanalysis with a modification of the setting or with a modified setting’; I would readily propose: psychoanalytic relation with an adjusted setting. I am well aware of the difficulty of finding an adequate appellation contrôlé, but I do not think that the difficulty of finding the right term can be permitted to delay any longer the urgent need for training in the practice of a singular technique that is justified by the facts.

Notes

1 Green, A. (1994). Un psychanalyste engagé, p. 148. Paris: Calmann-Lévy.

2 Cf. A. Green, ‘Mythes et réalités sur le processus psychanalytique. Le modèle de L'interprétation des rêves’, Revue française de psychosomatique, 19/2001.

3 The expression, now obsolete, was in vigour in the 1950s. It was also said, concerning the failures of analysis, ‘Many are called but few are chosen’.

4 Green, A. Preface to the book by François Richard et al., Le travail du psychanalyste en psychothérapie, Paris: Dunod: 2002; and, in the same work: ‘A propos de certaines tentatives d'analyses entreprises suite aux échecs de la psychothérapie. Le Syndrome de désertification psychique’.

2

THERAPEUTIC INDICATIONS

When a patient meets an analyst, two cases can arise. In the first, it is an inaugural encounter; the individual requesting the consultation has never seen a practitioner of analysis before, nor has he had any prior experience of analysis. In the second, the patient wishes to have a new experience of analysis, feeling that there is still work to be done and so addresses himself, on the basis of various indications, to the person whom he hopes will be able to help him. Lacan has designated the analyst, in the patient's imaginary world, as the subject who is supposed to know. No doubt it is necessary, from the outset, for the patient to imagine that the person he is seeing knows something about the mind and that he can enlighten him about his own. But this definition seems to give more of a phenomenological than a genuinely psychoanalytical account of the situation, even if the question is one of who is supposed to know in the patient's unconscious. In any case, during the first encounters – indeed from the very first – the analyst is going to find himself, roughly speaking, faced with two different situations. In the first, he is going to be dealing with a person with whom the encounter will unfold on several levels at once which will all need to be linked up. Even if he does not speak about it, the patient will react to the analyst's presence, to the presence of this particular analyst. In this reaction there will be a mingling of elements which already constitute a pre-transference, combined with others which are related to the analyst's particular personality. As the consultation unfolds, the thread of the pre-transference which, in fact, is already a transference, will be apprehended more and more clearly, and will sometimes be perceived by the patient (‘I don't know why, but you make me think of my uncle X . . .’).Within this transferential dimension, the patient, before or after talking about his symptoms and the reasons for his consultation, will tell a story, namely, that of his origins, his family or his parents, even though no specific question has been put to him by the analyst. He will himself react at certain moments of his story in what is sometimes an abrupt manner, which does not fail ...

Table of contents

• Front Cover
• Key Ideas for a Contemporary Psychoanalysis
• THE NEW LIBRARY OF PSYCHOANALYSIS
• ALSO IN THIS SERIES
• Title Page
• Copyright
• Dedication
• Contents
• Foreword
• Preface
• Translator’s acknowledgements
• PROLEGOMENA
• Presentation
• A brief subjective history of psychoanalysis since the Second World War
• PART ONE PRACTICE
• PART TWO THEORY
• PART THREE SITUATING PSYCHOANALYSIS AT THE DAWN OF THE THIRD MILLENNIUM
• Provisional conclusions
• Bibliography
• Index