A Fresh Look at Psychoanalytic Technique

Selected Papers on Psychoanalysis

Fred Busch

• Publisher: Routledge
• Year: 2021
• Print ISBN: 9780367621841
• eBook ISBN: 9781000428858
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This collection of selected papers explores psychoanalytic technique, exemplifying Fred Busch's singular contribution to this subject, alongside the breadth and depth of his work.

Covering key topics such as what is unique about psychoanalysis, interpretation, psychic truth, the role of memory and the importance of the analyst's reveries, this book brings together the author's most important work on this subject for the first time. Taken as a whole, Busch's work has provided an updated Freudian model for a curative process through psychoanalysis, along with the techniques to accomplish this. Meticulous in providing the theoretical underpinnings for their conclusions, these essays depict how Busch, as a humanist, has continuously championed what in retrospect seems basic to psychoanalytic technique but which has not always been at the forefront of our thinking: the patient's capacity to hear, understand and emotionally feel interventions. Presenting a deep appreciation for Freudian theory, this book also integrates the work of analysts from Europe and Latin America, which has been prevalent in his recent work. Comprehensive and clear, these works focus on clinical issues, providing numerous examples of work with patients whilst also presenting concise explanations of the theoretical background.

In giving new meaning to basic principles of technique and in reviving older methods with a new focus, A Fresh Look at Psychoanalytic Technique will be of great interest to psychoanalysts and psychoanalytically oriented psychotherapists.

1 Our vital profession

We’ve all heard the depressive views of our profession: the impossible profession; our dying profession; the pain of being an analyst; a dangerous profession, etc. Today, I am here to present our profession in a different light—the vital profession. I will not be Pollyannaish in presenting my view, as at times, our work is painful, and seemingly impossible. However, when we forget the vital nature of what we do, it can sometimes feel even more painful, impossible, dangerous, and daunting, and we forget about the endless possibilities of the mind.

From its beginning to the present, psychoanalysts have been working to help their patients find or re-find the core of what it means to be alive and human—that is, the human mind. No matter what our theoretical perspective, we are all trying to open up spaces in a patient’s mind that were previously closed off, and in this way, we help them re-find their mind. Our colleague, Marilia Aisenstein, captured this vital nature of our endeavor when she stated:

Analysis is uncompromising in relation to other therapies because it alone aims … at aiding our patients to become, or to become again, the principal agents in their own history and thought. Am I too bold in insisting that this is the sole inalienable freedom a human being possesses? (2007, p. 149)

One of Freud’s great discoveries, not put in these terms, was to help us realize that we all are living in a movie, with ourselves as writer, main character and director, driven by unconscious forces and the many defenses against them. However, like in Woody Allen’s movie, The Purple Rose of Cairo, where the character steps out of the screen to try and create a different life, we try to help our patients discover the movie they’ve been living, the forces that led them there, the dangers they fear in changing, and in this way help them to live the story of their choosing. It is one of the most important goals of psychoanalysis to help the patient gain the capacity for story-telling, and momentarily step outside the story and observe it as her story. The process of initiating this change is what I’ve called Creating a Psychoanalytic Mind (Busch, 2013b), which is unique to psychoanalysis. We try to set in motion a creative process that only the patient can complete, and in this way change the inevitability of actions into the possibility of reflection. What a momentous gain!

I think most of us have had the experience I will describe. It was early in my analysis when a song repeatedly came to mind. It was the Beatles singing, “Here Comes the Sun.” In words, music and the Beatles’ ability to capture a joy in living, the song indicated the lifting of my depression; the emergence of memories unavailable for many years; and the happiness associated with them. The thoughts and feelings were not something I could have consciously put in words at the time. Over the years this song reappeared throughout my analysis. What I want to highlight with this memory is that a song came to mind in analysis, persistently and unbidden, when I was ready, that helped me re-find a part of my mind, my experience, and my feelings—that had been lost to me. My mind had been closed off to a part of me that was the essence of who I was, who I could become, and who I then became. This is why I see psychoanalysis as vital. We try to give back to our patients the one indispensable component of being human—their mind—and the freedom and creativity that come along with it.

So yes, while psychoanalysis is, at times, an impossible, painful, and dangerous profession, let us not forget its vital nature. It offers our patients a new vigor in living.

The vitality of our method

Regardless of which Freud we follow, the important differences we have in our models of the mind, and some of the specific variances we have in analytic technique, there have been paradigm shifts in some of the most basic ways we approach our patients that serve as a new common ground among seemingly disparate points of view (Busch, 2013a).¹ These changes are based upon insights from colleagues from different perspectives over the last 40 years. Yet the profundities of these breakthroughs seem hardly to have been noticed. I think this is because these changes have been the result of an evolutionary process that led to their gradual incorporation into clinical practice, rather than the revolutionary methods some newer theories proclaim.² What we see are changes based on clinical practice within a broadly defined Freudian-based model,³ while incorporating other views of psychoanalytic technique. Let me start with a story.

The girl on the beach

Sitting on a beach I notice a young girl, looking for seashells about 15 feet from the water, in a place where there are very few shells. After a while her mother, who is there quietly helping her, says, “Would you like to go closer to the water, where there might be more shells?” The little girl says “yes,” but for some time continues looking in the same spot. A while later she moves closer to the water where she begins to pick up numerous shells.

I would suggest this observation might serve as a model for a current view of psychoanalytic technique. First let us deconstruct the event. The young girl is searching in a place where it is difficult to find what she seeks. She is like our patients who, caught up in unconscious conflict, keep looking for something to solve their problems, but end up searching in the same place and finding the same problems. The mother doesn’t tell her daughter to stop what she’s doing or get frustrated with her but wonders with the girl if it might be helpful to search for what she seeks somewhere else. In the mother’s wondering I would like to highlight the following. The little girl is not told what to do, she isn’t forced to search elsewhere, she isn’t told where she’s looking is wrong, but rather given a choice to explore somewhere else, someplace she hasn’t thought of yet, or might never have thought of on her own. In this way she is given agency to make her own decision. The little girl apparently thinks this is a fine idea but keeps searching in this same area that has not led to promising results. There is some resistance to moving away from her spot. The mother doesn’t make any further suggestions or give any other ideas, but after a while the little girl decides on her own, to move towards more fertile ground, and ends up with her desires fulfilled.

An everyday clinical moment

The patient, a 50-year-old literature professor, began a session by talking about the difficulty he had this morning in presenting to a committee on funding and in relating with his graduate students. For example, when talking with members of the committee he realized he wasn’t being specific enough, and in going over the work of his graduate students he realized they knew much more about the literature in their subjects than he did. He rationalized this at first by saying, of course he couldn’t know the literature in depth on every topic but realized that this was a problem he had in general—that is, getting into the literature. He then told of his secretary coming into his office to inform him of some changes in the university’s retirement plan, and he felt angry that she was bothering him with this. He had a sense there was something connecting all these events but couldn’t quite get it.

This difficulty in connecting his associations had been a prominent issue in the analysis for a while. The analyst then said to the patient, “It’s my impression that in these situations there is something about getting into details that you find aversive.” The patient replied, “I knew there was something like that, but I just couldn’t get into…(there was a pause as the patient searched for the word)…the details (he laughs).” The patient then said, “I just remembered a part of a dream. Pause. This is embarrassing. In the dream I had a bowel movement, and I couldn’t get myself clean. I can’t remember anything else. I always want to be so clean.” The analyst then said, “Maybe the dream is telling us why.”

Like with the mother of the “girl on the beach,” the analyst isn’t telling the patient to look somewhere for his problem with an interpretation, rather he first helps capture the patient’s problem expressed in his associations via a new representation (i.e., problem with details). The patient then remembers a dream, which suggests that by not getting into the details he is enacting a fantasy of making a shit mess. He then defends against this by saying how clean he has to be, like the girl taking her time before going closer to the water. The analyst doesn’t try and force him back into the mess, but helps the patient see that his defense of being clean is related to the wish to make a mess.

There are two additional, related factors about this clinical vignette that I’d like to draw your attention to. The first is that I think it would be difficult for many to guess the analyst’s theoretical perspective, and the second is the analyst’s approach integrates certain changes in how we think of technique to be elaborated in the next sections. As a preview, in his first intervention the analyst follows the patient’s associations to make an unsaturated (Ferro, 2002), analyst-centered (Steiner, 1994), clarification (Bibring, 1954) in the here and now (Gray, 1994; Joseph, 1985) to represent a preconscious (Green, 1974) defense in the manner of Anna Freud (1936). It leads to a dream that elaborates the unconscious meaning of the defense, followed by an undoing, which is brought to the analysand’s attention with another unsaturated, analyst-centered intervention.

Our changing methods

The two most significant paradigm shifts in clinical psychoanalysis came about with a change in focus from working directly with the unconscious, and searching for what has been repressed, to the general recognition across theoretical perspectives that it is important to work more closely with what is preconscious, and the emphasis on building representations of what was previously un-thought, or under-represented, as well as what was repressed. These changes are designed to make our interventions more understandable and emotionally meaningful to our patients, based on our increasing understanding of the mind from a variety of psychoanalytic sources. For too long we’ve labored under the belief that we needed to interpret in a way that the patient directly experienced his unconscious (Strachey, 1934), without taking into account all that needed to occur before unconscious ideation or feelings could be meaningfully taken into awareness.⁴

Preconscious thinking

We have moved from primarily confronting the patient with what the analyst gleans from the patient’s unconscious, to working more closely with what the patient is able to hear, understand, and potentially integrate. In this way we’ve realized that in order to help a patient grasp how they are ruled by unconscious fantasies, self-states, conflicts, etc., these have to first become understandable.⁵

Except for the French school, preconscious thinking has remained a “shadow concept” (Busch, 2006), if a point of consideration at all. In 1915, Freud tried to strictly distinguish between unconscious and preconscious thinking on the basis of “word presentations” and “thing presentations.” However, buried in this paper is Freud’s puzzlement over the fact that “A very great part of this preconscious originates in the unconscious, has the characteristics of its derivatives, and is subject to censorship before it can become conscious” (1915, p. 191), and that there are thoughts that had all the earmarks of having been formed unconsciously, “but were highly organized, free from self-contradiction, have made use of every acquisition of the system Cs., and would hardly be distinguished in our judgment from the formations of that system” (1915, p. 190, my italics). Thus, in contrast to everything else he’d written in this paper, Freud briefly conceives of complex preconscious thinking with infusions of unconscious elements. In these few sentences, Freud, still in his topographical model, presents a view of preconscious thinking that goes from a permeable border of the system Ucs. to the permeable border of the system Cs.⁶

If understood in this way, there are various levels of preconscious thinking at which we are working that make our task more complex. For example, the sexual derivatives that appear early in the treatment of a hysterical patient would be worked with differently compared to similar derivatives that appear in the later p...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• Permissions
• Introduction
• 1 Our vital profession
• 2 The search for psychic truths
• 3 In the neighborhood
• 4 Thoughts on unconscious resistances
• 5 Some ambiguities in the method of free association and their implications for technique
• 6 What is a deep interpretation?
• 7 Are we losing our mind?
• 8 Conflict theory/trauma theory
• 9 A shadow concept: preconscious thinking
• 10 Distinguishing psychoanalysis from psychotherapy
• 11 “I noticed”: the emergence of self-observation in relationship to pathological attractor sites
• 12 Can you push a camel through the eye of a needle?
• 13 Searching for the analyst's reverie
• 14 Telling stories
• 15 I love you that's why I ignore you
• Endmater
• Index