Two More Central Clinical Issues;
Interpretation and Reconstruction:
Interpretation is the psychoanalytic act, reconstruction is the work of the psychoanalyst. Both are clinical psychoanalysis.
The Interpretation of Dream changed psychoanalysis in a fundamental way. Before that work, the patient was supposed to retrieve the repressed from behind the wall of repression with the help of hypnosis or the analyst’s persuasion. In the ‘Interpretation of Dreams’ Freud showed in a clear convincing way that the manifest dreams could have implicit expressions of the repressed. Relating those findings to the patient comes through interpreting the dream. In a simplistic and misleading way, interpreting a dream meant then to bring the latent meaning of the dream out of its manifest content, through what the associations bring to the dreamer’s mind. It is simplistic in terms of the theory of repression, because it turns the unconscious meaning or the latent into a content already formed and just awaits removing its disguises to reappear in consciousness. It is misleading because the act of interpretation- in those terms- is an act of discovering an already existing meaning and delivering it to the patient (the most common mistake in practice till now is giving the dream or the any other psychical function a psychoanalytic meaning, as if it stands for the repressed meaning).
There is an unclear notion in Laplanche and Pontalis’s definition of ‘interpretation’ in The Language of Psychoanalysis about the problem of secondary elaboration in dreams and how interpretation has to deal with the latent meaning of a dream or a symptom that is product of some sort of secondary elaboration that must have made changes to the original meaning. This notion, makes us reconsider the common meaning of interpretation as an act very similar to linguistic translation (English to French). Interpretation-at least in psychoanalysis- is more than saying the same thing in two different ways: love is amour (linguistic interpretation) and love is a noble feeling (an interpretation of value). To give an example of a psychoanalytic interpretation that considers the working of secondary elaboration I refer you to the dream of The May-Beetle Dream, (The Interpretation of Dreams, Vol.1,287-289). Freud mentioned in that dream associations of a compulsive idea the dreamer suffered from. The compulsive thought was asking her husband to hang himself. The associations revealed a wish he would get an erection by any means. The plea to hang himself was a secondly elaborated wish to get an erection. Interpretation is thus not attaching a meaning to a text, but deciphering a hidden text within the text that is the source of the sought after meaning,
Interpretation should be taken as the act of psychoanalysis itself because we deal with texts that comprises the other textual meanings. Better, the psychoanalyst does not do anything that is not interpretational because the patients’ material in itself is interpretation of something else. Ricoeur concluded form his study of psychoanalysis that interpretation in analysis as one of two acts: demystifying of illusions and restoration of meanings. In analysis, we are presented with the patient’s explanation and understanding of old or currents events within a transference relationship. We work through his material over and over (unsystematically) so both he and I would demystify the illusions piled up in the material over the years and in the guidance of the neurosis. What I got from Brenner’s direct and indirect writings about ‘working through’ is something akin to Ricoeur’s demystification of illusions; irrespective of the patient’s correctness or incorrectness of his conception of those events. Working through them will reveal to the patient which are actual memories or recollections of memories and which have been transformed into illusions. The tedious work of working through might include some interpretative contribution from the analyst but what is important is how they get better reorganization every time they are recounted in the nalysis. The illusionary nature of this material would gradually be demystified. Dealing with transference serves another function. Transference is regressing to a point in the patient’s development where he formulated a relationship or relationships with others. Interpreting transference phenomena restores the meaning of the original enacted relationships and reveal to the patient the meaning of the relationship with the analyst (or others whom he relate to in a similar way) in order to restore the distorted or repressed meaning.
In my time (long ago) and I believe till now to some extent, candidates are taught that interpretation is the act of connecting, relating, referring unconscious psychical entities to the system conscious. We were taught to listen and intuitively (sometimes methodically) note in the associations what could be leading to that unconscious. The unconscious was an ontological entity that is of topographical present, has a force and pressure, and has a role in the psychoanalytic setting. The first time I was delighted to know that my unease with explaining interpretation that way has some merit was in my supervision with Clifford Scot [ He was a Kleinien veritable]. I was telling him about my patient who was very troubled that he was constantly watched by his dead mother in everything he says or does. Unexpectedly, Scott asked me to find out from my patient where would his mother be when she watches him doing what says he does. To cut it short, this condition was related to infantile masturbation. However, when I discussed the matter with Scott and did my own thinking too, I realised that I am not supposed to look for ‘an unconscious’ but discover if there is one in the first place, which should be the patient’s unconscious. He almost said to me you do not assume that there is unconsciousness until you find it. This was the difference between practicing psychoanalysis and using it. In 2011, I published a book entitled “The Clinical Application of the Theory of Psychoanalysis”. It was a mistaken title because (I hope)in the four case histories as I see them today I believe I did not forget what I learned from Clifford Scott in my practice.
As such, the act of interpretation in psychoanalysis takes a very different meaning from the common meaning or the implicit meaning we give it in psychoanalysis. Interpretation in psychoanalysis is to demonstrate to the patient the arbitrariness of the link between his signifiers and their signified. In a very crude way, we show the patient that his neurosis (signifier) is arbitrarily linked to infantile experiences and relationships (signified), therefore it is not possible to refer it to particular source. This means that psychoanalyzing him is not to discover what made him sick but how he became sick. This might sound strange if we neglect that the term interpretation does not belong the sphere of logic but to the sphere of semiotic ( see a paper we assume we all received from Semetsky few weeks ago about semiotics). A signifier has the potential to carry many meanings or signifieds (hang yourself for instance). But each signified could be a substitute for something else (get an erection, show me that your care, go to hell, etc.). Therefore, interpreting the combination of hang yourself and get an erection depends on what is called in semiotics “interpretents” i.e., Freud got the interprtentent from dream of the May-beetles.
If interpretation is the act of psychoanalysis then the work of psychoanalysis is reconstruction (construction). Freud used the term construction (1937 b) to what we now call reconstruction. He said (261): “If, in accounts of analytic technique, so little is said about ‘construction’, that is because ‘interpretations’ and their effects are spoken of instead. But I think that ‘construction’ is far more appropriate description. ‘Interpretation’ applies to something that one does to come to single elements of the material, such as an association or parapraxis. But ‘construction’ when one lays before the subject of the analysis a piece of his early history that has been forgotten …”. Yet he also stipulated that the work of construction is the ongoing work of analysis that does not follow a systematic sequence or course(260). Thus, we interpret to reconstruct. But what and Why to reconstruct?
I underlined the point that interpretation brings out the dormant meaning in the link between a signified and its signifier. The meaning that the interpretation brings out becomes a signified on its own, which requires interpretation; and so on. In the example of the May-Beetles, the interpretation of ‘hang yourself’ was: get an erection. But get an erection (in this way) needs an interpretation, because it could mean ‘get lost if you don’t or prove to me that you love me, etc.. In an analysis that lasts for few years and for hundreds of sessions, interpretations and the links between interpretations require, but demand, reconstruction from time to time, simply because reconstruction brings in material from other interpretations that are of significance. Reconstruction is simply putting order in the disorder of the network of exchanged meanings over the course of the analysis. It is noticeable that in very long analyses the meaning of the analysis (the purpose, criterion, the sign of termination) gets lost. The reason is that the process of reconstruction should eventually replace the daily act of interpretation, because if that act is not checked it would never come to any reasonable end. Analysis would lose its purpose. As the competence of the analysts appears in his choice of the ‘interpretant’ in his choice of interpretation, it also shows in honing in on the main theme of reconstruction he uses at a certain moment.
When I was winding down my practice to retire and old patient asked me for a consultation regarding her aunt. The reason was that the lady was showing signs of anxiety and inability to persist to finish any task she starts. She was also neglecting herself and her material life. Otherwise she was reasonably functional and taking care of herself and was not showing any alarming symptoms. She has seen a psychiatrist few times and he prescribed some mild antidepressant (“because she was not so depressed”). He also referred her to a neurologic who did not find anything neurological wrong with her. Her niece added to the picture that her aunt was negligent of herself and her place of living. They both requested that I continue seeing her as long as I can, and think about referring her to a colleague in the city when I stop seeing patients anymore. I accepted seeing the lady twice a week for the time being on the condition that if I see that she needs to continue with someone else they will follow my recommendation. The lady was pleasant, communicative, and was involved in the whole process of assessing her condition and my decision about seeing her. She was close to retirement from her job as professor in a college in the city
She started by giving me a good detailed account of her life. She had a pleasant childhood and reasonable mature parents of her and three other sisters. She had a good education. She had a regular steady marriage but without fireworks, or children. Her husband died ten years previously. She enjoyed her job which she was to retire from soon, and expressed some apprehension because that because the job was organizing her life and giving her somethings to keep her mind active with familiar things she almost do by “habit”. She averred that the sessions would (and started to) give her something new that organized her life. There were very few interpretations at that stage, because she was just exploring talking about herself which was very new to her, and I was also refraining from opening topics that I was not going to follow up on. However, there came a moment when I mentioned that she is telling about herself as if she was reporting on someone else. Her reactions were close to being surprised to see how distant she is from her feelings, and herself. To my surprise, she added that all the people she knew were like that. This would have been a very opportune moment to explore several areas in her history in a normal psychoanalysis but I refrained from starting something I would not be there to follow.
What was subtle but clearly troublesome was the way ideas were most of the time unrelated to each other in her mind. There was some sort of ‘thought salad’ in her speech but she always became aware of that spontaneously and made great efforts to create connections-sometimes false- between the dissociated thoughts. I did not make any comment on that though I was a little concerned about early dementia but I decided to leave that to the next analysts to deal with (in my referral letter I recommended a thorough neuro psychological testing).
In one of the session, she was talking about her apartment. She said that it is a beautiful apartment overlooking the lake but it is so cluttered with useless and ugly old things that it is not pleasant anymore to live in. She continued describing it in some detail. I said that if I didn’t know that she were talking about ner apartment I would have thought she was talking about her mind. She gazed at me for a couple of minutes, shock her head, and said “I see”. I put my remarks to her in a more detailed way; sort of reconstructing few of my interpretations in one observation about how her manner of thinking reflects feature of her daily life. She listened attentively. At the end of the session she said that she would like to tell me about somethings and she feels embarrassed about. She started the next session- after few minutes of hesitation- to tell me about her sexual life. Briefly, as a child, she was always worried about her continuous sexual arousals and felt confused by them. She felt equally confused (literally) after masturbation. She said that she continued that way even after her marriage. From her description, she was experiencing mild dissociative episodes during those sexual excitements. Exploring this aspect with her more revealed that she had what could be described as dissociative states or ‘ scramble ideas’ with no clear way to stop them.
I realised that her visits to me were changing faster than I expected, and the issue of sexuality must have more implications than the original reason for her referral. I worked out some partial reconstructions regarding her anxiety, confusion, lack of interest in finishing what she starts, her fear of having more time than what she could fill with activity in the context of what she told me about her sexual life. When I was reasonably assured by her responses to the constructions I suggested I referred her to my colleague. Both he and her stated a more stable analytic work.
As a summary of my opinion of reconstruction: reconstructions give interpretations their subjective identity; they become psychical products of the patient’s material and put them within his personal perspective. They also stimulate his mind to assimilate the many interpretations as the background of his insight. Most of all, reconstruction when done strictly as product of the patient’s association and not laced by some psychoanalytic conception they do the desired changes without attempts at keeping them as guiding rules for future problems. As a model to this technical mistake I quote a reconstruction of material from a clinical case I came across lately. The Analyst says: “To this point, our (!?)focus has been on the way in which sadomasochism manifested itself relationally and we (!?) used Fairbairn to help us understand the underlying endosomatic situation- namely….”. The paper is not clear if this was the reconstruction given to the patient or only the construction the analyst had in her mind and would build from it the reconstruction that could be given to the patient. This not a construction in the psychoanalytic sense, it is an educational theoretical mumbling.
Interpretation and reconstruction are the most confused concepts in the minds of the younger generation of psychoanalyst. The reason is the way training is being done. Training in the traditional institute system is founded on the idea of transmitting knowledge and experience from one generation to another. In psychoanalysis, the difference between experience and knowledge is none existent. So, candidates confuse knowing and practicing what they know. Better, the system gives the illusion that if you know what is relational theory or Kleinian theory then you can just practice it. You can learn the holy book of your choice as you like, but to be pious will not come to you from just what the Book ort the holy man has said. Psychoanalysis is too big, sophisticated, and advanced to be taught in our institutes.
We face irrational resistance to this blatant fact. I will try in the last part of this posting to address this resistance.