Psychoanalysis: Between Improving and Changing

4. The Gap Between Theory and Practice:

In the early years of the psychoanalytic movement psychoanalysis was a term that denoted one meaning: what analysts do, which for several decades remained the same: psychotherapy, and only psychotherapy. Neither Freud nor the pioneers acknowledged that what they were doing, by practicing psychoanalytic psychotherapy was mostly discovering the nature of the human subject: unconsciousness, defensiveness, the pervasiveness of childhood constructs in psychical life in maturity, the conflictual nature of psychical life, and the split of consciousness, etc. Because of the novelty of the discoveries and Freud’s continuous work on a theory for those discoveries a subtle gap (which I will depict a little later) opened between clinical practice and theory. Clinical practice was without a theory, and the theory of the subject was yet to come, because Freud was continually changing its parameters. The gap between theory and practice was subtle to the extent that psychoanalysts did not notice its existence and its possible effect on the advancement of psychoanalysis. The continuing increase in the knowledge of the human subject that was accumulating with time and experience engendered some change in ‘psychoanalysis’, but did not deal with the gap between theory and practice.

Without serious consideration of what psychotherapy was accomplishing on the one hand and the analysts’ assumptions of psychopathology on the other, the two wings of psychoanalysis seemed working independently. Psychopathology could not get a separate formulation from the formulations given to practice. This detail entrenched the notion that psychoanalysis is merely a profession of psychotherapy. Because the act of therapy was technically undefined and cure was similarly vague, analysts did not distinguish between what they aspired to achieve in psychotherapy (strengthening the ego against the attacks of the instinctual pressure, for instance) and presuming that psychopathology is a result of the weakness of the ego defenses against demands of the instincts: ego psychology). Something worse in my opinion dug roots in our conception of psychoanalysis and its derivative psychotherapy. Analysts got accustomed to ignoring the paradox of using theory to confirm practice and consider practice the proof of the validity of the theory.

Freud’s advanced thinking in that regard made him improvise metapsychological conceptions that worked well- for a long time- in bridging the gap between psychotherapy and psychopathology. He considered metapsychology essential in the construction of theories (‘Analysis Terminable and Interminable (1937’).  After the demise of ego psychology and the birth of relational psychologies there was no place for metapsychology in psychoanalysis anymore, but there was no replacement for it either. The reason is that metapsychology needed “issues” to replace and to signify.  Relational psychology does not provide issues (like ego strength and defense mechanisms). It is only fair to say that at the early stages of establishing psychoanalysis as a method of psychotherapy it proved to be more than merely a technique of psychological treatment because it was always had a feedback that enriched the theory. That feedback from clinical work widened the scope of psychoanalysis beyond any expected improvement in psychotherapy, or the clinical aspect of psychoanalysis.

I have to interrupt this line of thought for a while to put in focus a commonly neglected fact. Freud’s discovery of infantile sexuality, the three types of the unconscious we encounter in practice, the working of the primary and secondary processes, narcissism, and reversing the theory of anxiety (1926), among other things were enough and could have unify the psychoanalytic theory of the subject and the practice of psychoanalysis in one comprehensive human science. Understandably, but still regrettably, analysts were concentrating on creating a profession of psychotherapy and showed no interest in creating a theory of the subject and the science that emerges from it. They insisted that psychotherapy is the only true source of the function of psychoanalysis.

Going back to the issue of clinical psychoanalysis I would say that the intentional or unintentional avoidance of thinking about psychoanalysis as the background of psychotherapy turned the way it was practiced at that time into a set of blind beliefs. Analysts followed the original manner of practice (in terms of the duration of the sessions and the number session per week, the couch, and some other details a bout payment, vacations, etc.) as a “protocol” to follow; yet it was a protocol taken out of context. Those features in the protocol became integral components of the work of therapy itself. In other terms: clinical psychoanalysis was replicating the circumstances of its practice forty, fifty, a hundred years ago without knowing those circumstances. Those circumstances became blindly paradigms of the profession of psychoanalyzing. In fact, the couch was Freud way of avoiding the tension of being looked at by the high number of patients he saw a day. The number of sessions per week was decided by the demand from candidates who came from different cities and towns and later from other countries for quick training. Normalizing the conditions of doing therapy is one of the most perceptive clinical intuitions Freud came up with, but we have to understand his approach instead of idealizing blindly what our forefathers did. Just as a hint: psychoanalysis is analyzing the intrapsychic core of the subject through the transference scenes. Thus, the analyst has to remain anonymous, neutral, and able to abstain from reacting to the patient’s unconscious demands in order to interpret and reveal the unconscious component in the patient’s associations. This protocol of practice corresponds to the classical theory of psychoanalysis (Fayek, 2017).

After Freud’s death psychoanalysis started to fragment into camps. Ego psychology versus relational psychology was the first to ensue among the English-speaking analysts. In the Latin-based communities, the split was between functional psychoanalysis and structural psychoanalysis. (In January of 2019 I posted on Freud: A reluctant structuralist). The main issues in the Anglo camp pertained to clinical and practice matters. There was more strict adherence to the old-fashioned system of performing analysis in terms of the number of sessions per week, the duration of the session, the length of analysis, and a blind adherence to some superficially understood rituals in the relationship between analyst and patient. In that camp psychoanalysis was a profession that already has technicalities to follow. The Latin camp of psychoanalysis was concerned more with discoveries in human nature which required thinking to comprehend and reach its underlying conceptions of practice. Most all, analysts in that camp were shedding off the apparent functional thinking of the pre and post Freud’s neglected revision of the theory of anxiety (1926).  In that work Freud was struggling hard with the traditional cause\effect, or functional understanding in psychoanalysis (Originally anxiety was regarded a function of failing defense mechanisms) and shed light on a structural understanding of anxiety as the initiator of psychical dynamics.

The structural maturation of psychoanalysis as a theory of the subject or the discovery of the intrapsychic core of our psychological life started in the thirties of the last century with the birth of general structuralism, which changed the face of the humanities for good. Up to the late fifties psychotherapy was still as it was all that time: interpreting the present by the past, with some additions coming from insights in regard to the difficulties encountered in the psychotherapy of new types of patients (character disorders). WE gained new vision of resistances). Instead of creating a parallel theoretical refinement analyst endeavoured to expand the field of psychotherapy unwisely by expanding the available theoretical formulations of the time to fit those new psychoapathologies. In other words, psychoanalysts, who were still mainly physicians, were not equipped to give those gaps enough thinking to realize that the discoveries of psychoanalysis exceeded the limitations of their theoretical knowledge and their technique of psychotherapy.

So, what is the basis of the discordance between analysts, which plagued psychoanalysis from the beginning of its inception? At the beginning the discrepancy and disagreements were about some concepts like interpretation, transference, resistance, but also about their meanings and their impact on practice. The discrepancy between the ‘ideal theory’ and the pragmatics of practice was the core problems since the early psychoanalytic movement. In the forties the conflicts were about what is the best medium to explore the unconscious? Defenses, relations, ego, i.e., the equivalent of the ego in interpersonal relationships or the self. Psychoanalysis as the act of understanding psychical phenomena gave its place to the conflicts about it. The topics of the conflicts became the psychoanalysis of today.

The issue of this this post brings us face to face with the deterioration of psychoanalysis.