Tag: analytic pair

the therapeutic encounter is a mess, so to speak, of sheer humanity…

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In his last works, Ferenczi seeks unconventional ways of expression in order to break through the wall of words that had become all too familiar and automatic, with the assumption that “if we only stick to a strictly defined setting, we will automatically further the positive outcome of the therapy”. That is to say that we would be rewarded for the merits of our discipline, by strictly adhering to the rules, tying the analysand to a procrustean bed and stretching or cutting him to fit the bed size. As a matter of fact, the therapeutic encounter is a mess, so to speak, of sheer humanity, where no reliable laws apply, as Ferenczi experienced it for the worst and the best in the cases described in the Clinical Diary, without the paternalism implicit in purism. He is aware of our epistemic fallibility and he does not forget our propensity to err, “the map should never be confused with the territory”, as he writes (Ferenczi, 1932, p. 75). The personality of the analyst, as we have seen in Balint’s humorous sketches, cannot be ignored; the little trifles, the spices, are often more important than strictly following the instructions of the recipe. Ferenczi anticipated this difference, as is mirrored in his texts. For a long time, Ferenczi feared that, if he did not follow Freud’s lines and “recipes”, this would make him a poor analyst. In the early 1930s, however, he underwent a positive change towards more independence. He developed and increasingly trusted his own way of thinking, as is reflected in the Clinical Diary.

Judith Szekacs-Weisz; Tom Keve (2012-01-06). Ferenczi and His World: Rekindling the Spirit of the Budapest School (The History of Psychoanalysis Series) (Kindle Locations 1685-1696). Karnac Books. Kindle Edition. 

undisturbed friendly interest

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J. T. could not tolerate the response to his enquiry “What is your trouble?”, “It’s my kidneys doctor.” “Kidneys! What do you know about kidneys!” (or liver, or stomach, or whatever other anatomical structure or physiological function to which the patient chose to refer). It offended both his medical knowledge and his sense of propriety. The patient, frightened at having given offence to such an eminent authority, would close up and volunteer no further suggestions lest a further storm be evoked.

Trotter, on the other hand, listened with unassumed interest as if the patient’s contributions flowed from the fount of knowledge itself. It took me years of experience before I learned that this was in fact the case. When a patient co-operates so far as actually to present himself for inspection, the doctor from whom help is being sought is being given the chance of seeing and hearing for himself the origin of the pain. No need to ask, “Where does it hurt?”— though it would clearly be a comfort to have his query answered in a language that he understands. The anger that is so easily aroused is the ‘helper’s’ reaction to an awareness that he does not understand the language, or that the language that he does understand is not the relevant one or is being employed in a manner with which he is unfamiliar. Trotter’s undisturbed friendly interest had the effect of eliciting further evidence from the patient; the fount of knowledge did not dry up.

It was said that when Trotter did a skin graft it ‘took’; if Taylor did a skin graft— with equal or maybe even greater technical brilliance and accuracy— it did not take; the body rejected it; it was sloughed off. This I did not see, but that the story was told was itself significant of the impression that was created by the two men on their students.

Bion, Wilfred R. (1991-12-31). All My Sins Remembered: Another Part of a Life & The Other Side of Genius: Family Letters (Kindle Locations 562-576). Karnac Books. Kindle Edition.

edin balint on waiting and transference

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Her place in the psychoanalytic firmament is an interesting one. In terms of psychoanalytic genealogy, she descends from Freud via Rickman (and less directly via Winnicott, who was analysed by Strachey), and from Ferenczi and the Hungarian tradition via, again, Rickman, with Balint added in; this background, together with more than a little respect for Klein’s thinking, creates a recipe for a unique position. Enid Balint’s own gifts, already available to her by the age of thirteen, and certainly visible to her schoolteachers, underlie these later influences, which gave rise to her own voice. To end, I would like to quote some of Enid’s own words, as spoken to another analysand, Juliet Mitchell, about her own way of analysing.

The small thing that the patient tells the analyst is probably not in itself what matters, but what matters is not some big thing either. What the small thing leads to may be some other very small thing, perhaps from the past. What often happens in analytic work is that the patient brings something about the neighbour smelling horrible, or something nasty in this particular room this morning; who has been there perhaps. You listen. You don’t say anything then; you don’t make an interpretation which turns it into something important, about the smell of a mother, or whatever. If you do that, you may be neglecting and misunderstanding the patient by understanding too quickly. You have to wait and see what it is about, and perhaps you find it is about a smell when the child was small, or perhaps something quite different. You don’t know to begin with, but if you come in too soon with an interpretation, you might miss a dream, for example, by interrupting the flow of association. In my view it’s much easier if you have an association, then maybe a dream, then more associations; and then you get back to the bad smell at the beginning. But if you come in too soon, you are doing what I am anxious about at the moment, both in general practice but more so, much more so, in analysis, which is that people may hang on to set-piece interpretation. I think we have given up the idea of its being all the Oedipus complex, or all parental neglect, or all anything. We get tiny little important details which really make things alive for the patient, and then, once you do that, the patient tells you something different and unexpected. That is the transference in the true sense.

Judith Szekacs-Weisz (2012-09-10). Ferenczi for Our Time: Theory and Practice (The History of Psychoanalysis Series) (pp. 97-98). Karnac Books. Kindle Edition.

the one collaborator in analysis

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What I want to draw attention to is this idea that the human animal has a mind, or a character, or a personality. It seems to be quite a useful theory, and we behave as if we thought it was more than that. When it comes to being psychoanalysts and psychiatrists, this cannot be treated as if it were simply an entertaining theory. Nor do patients come to see us because they are suffering from an entertaining theory. We could say that there is one collaborator we have in analysis on whom we can rely, because he behaves as if he really had a mind and because he thought that somebody not himself could help. In short, the most important assistance that a psychoanalyst is ever likely to get is not from his analyst, or supervisor, or teacher, or the books that he can read, but from his patient. The patient—and only the patient—knows what it feels like to be him or her. The patient is also the only person who knows what it feels like to have ideas such as that particular man or woman has. That is why it is so important that we should be able to hear, see, smell, even feel what information the patient is trying to convey. He is the only one who knows the facts; therefore, those facts are going to be the main source of any interpretation, any observation, which we are likely to be able to make.

Wilfred Bion, Italian Seminars, Seminar 1 Rome, 8 July 1977 Copyright © 2005 The Estate of Wilfred R. Bion

the primary of perception and attention

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Eigen (2005), whose thinking represents well the Romantic sensibility in psychoanalysis, sees the analyst as more of an agent who evokes new experience than an instrument for understanding what is. Similarly, Lacan has suggested that the purpose of interpretations is to “make waves” (Eisenstein , 2007). Openness to traveling the emerging pathway, what Casement (1985) calls “learning from the patient,” is a sine qua non of an analytic process that seeks to expand the patient’s ways of being (Summers, 2005a ; 2012). It follows that the analyst must adopt a technical stance of not knowing. The tempting desire for omniscience among those who sit in the analytic chair runs the underappreciated danger of suffocating the openness required for self formation (Eigen, 1993a). Interference with the analytic space can be subtle, but the consequences may impair the patient’s freedom to explore the unknown. It can be seductive for both parties to enact the roles of knower and known, but the more the analyst is able to sustain the openness of the analytic space, the greater is the opportunity for the analysand to uncover new possibilities.

Although Bion’s admonition to greet every analytic hour without desire or memory is fanciful on its face, one can appreciate the spirit of Bion’s interpretation of the analytic stance as openness to the unknown. Eigen (1993a) interprets Bion’s dictum as an injunction to “opt for the primary of perception and attention over memory and knowledge” (p. 125) and cautions that attempting to control where the truth goes risks imposing on the emerging truth of the patient’s experience. And here we come to a fundamental shift in the analytic stance. We have now reconceptualized the analytic task from knowing the patient to engaging her being, an analytic attitude suggestive of Heidegger’s (1968/ 1954) concept of openness to Being. When the analyst adopts this way of attending to the patient, he has shifted his top priority from discovering new knowledge to receiving the being of the other. This interpretation of the analytic task does not obviate the role of understanding; it sees the value of insight in its ability to make contact with and expand the patient’s experience. In this sense, contemporary analysis accords with the Romantic value system articulated by Fichte’s (1848) statement that Being is prior to knowledge. Knowledge, or self awareness, subserves the creation of new ways of being and relating.

Summers, Frank (2013-05-20). The Psychoanalytic Vision: The Experiencing Subject, Transcendence, and the Therapeutic Process (p. 53). Taylor and Francis. Kindle Edition.

living human speech

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The analyst’s speech must be the creation of a person who is alive in that moment. Living human speech is as difficult to come by in the analyst’s spoken use of language as it is in written prose or verse.

Ogden, Thomas (1999-12-31). Reverie and Interpretation: Sensing Something Human (Kindle Locations 156-158). Karnac Books. Kindle Edition.

on the art of psychoanalysis

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Among the most astute comments concerning what it means for an analysis to be alive has come (as one might expect), not from an analyst, but from a novelist and essayist, speaking in 1884 about the art of fiction:

The good health of an art which undertakes to reproduce life must demand that it be perfectly free. It lives upon exercise and the very meaning of exercise is freedom. The only obligation to which in advance we may hold a novel, without incurring the accusation of being arbitrary, is that it be interesting. [Henry James 1884, p. 49]

James’ statement about the novel (and implicitly about the relationship of writer and reader) has important relevance to the art of psychoanalysis and to the understanding of the relationship of analyst and analysand. The idea that above all an analysis must be interesting is for me both self-evident and a revolutionary conception (cf. Phillips 1996). To be interesting, the analysis must be free to “exercise ,” to shape itself and be given shape in any way that the participants are able to invent. The freedom to “exercise” is the freedom to experiment : “Art lives upon discussion , upon experiment, upon curiosity, upon variety of attempt , upon the exchange of views and the comparison of standpoints” (H. James 1884, pp. 4445). When the analysis is alive, it unselfconsciously manages for periods of time to be an experiment that has left the well charted waters of prescribed form; it is a discussion fueled by curiosity and by variety of attempt; it is an endeavor that depends upon genuine exchange of views and comparison of standpoints.

Ogden, Thomas (1999-12-31). Reverie and Interpretation: Sensing Something Human (pp. 7-8). Karnac Books. Kindle Edition.

the effort to become human

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…I believe that the analytic task most fundamentally involves the effort of the analytic pair to help the analysand become human in a fuller sense than he has been able to achieve to this point. This is no abstract, philosophical quest; it is a requirement of the species as basic as the need for food and air. The effort to become human is among the very few things in a person’s life that may over time come to feel more important to him than his personal survival.

Ogden, Thomas (1999-12-31). Reverie and Interpretation: Sensing Something Human (Kindle Locations 184-187). Karnac Books. Kindle Edition.