3. Psychoanalysis and Psychotherapy: The Uncomfortable Duo.

      This is the most unappealing title for this part of the post, but I could not find another to express my aim of writing this part:  the distinction between learning psychoanalysis and training in psychotherapy, which is also the difference between psychoanalysis and other psychotherapies.

The birth and evolution of the idea of psychotherapy came from Freudian psychoanalysis. Thus, when Adler and Jung split from the Freudian movement, to form their psychoanalytic schools, they took it for granted that they should also have their own specific psychotherapies. There is no required link between building a psychoanalysis and creating ‘a psychotherapy’ for it. In fact, psychotherapy-the Freudian one- was created by using the discoveries that he made in the field the psychology of the subject and psychopathology to effect some therapeutic changes in the patients he worked with. Psychotherapy was always a step behind the theory and was never an area of examination or separate discussions as the theory was.

Transference, is the best example to show how simple and fragmented clinical observations led Freud to that concept, and how it made psychotherapy an issue in psychoanalysis. The significance of that discovery made Freud consider some ‘recommendations’ for practicing psychotherapy and created sort of a protocol of practice (1912). Freud’s clinical protocol was thought of when the manifestations of transference promised going back to when the intrapsychic was formed, better, deformed. The recommendations for good practice were very much to give transference all the space it needed to be ‘interpreted’ in order to reconstruct the intrapsychic as it appears in dynamics of transference. There are two more items of the protocol that were seldom discussed: the frequency of the sessions and the fixed time of the sessions.

          Early Uncomfortable Duo:

      Psychoanalysis generated a psychotherapeutic modality influenced by the protocol (neutrality, anonymity abstinence). In the early years of training and learning psychoanalysis some analysts took the protocol out of its context of working with transference (better though, working with the patient’s material as transference material) and turned it into rituals, which with time get separated from its purpose and become aims in their own right. The protocol was taken as the condition necessary to effect cure. Some analysts adhered to it, sometimes, in comic ways (a good number of analysts, of the early phase, used silence as a method of interpretation). Those analysts did not explain to their patients and supervisees the logic behind the protocol; thus, psychoanalysis had an almost mystical reputation of being unique. Psychoanalysts were quite pleased and protective of this reputation and worked to emphasize it, by exaggerating its uniqueness in their regular behaviours.

Psychoanalysis brought the concept of the psychic out of neglect, ignorance, and misunderstanding. The concept of psychotherapy- separate from psychoanalysis- eventually emerged, not as an application of a fringe psychoanalytic theory but as a possible new approach to working with patients. Psychologists were encouraged by the growing acceptance of psychopathology and the treatment of the psyche and felt that they too have something to say and do. This is when psychoanalysts had to compete and find ways to distinguish psychoanalysis from other psychotherapies. At this point I have to use an anecdote to underline a point. While still in Egypt before getting my official training in psychoanalysis I got in a discussion (argument!!) with a behaviour therapist who was my professor of psychology and taught me behaviourism (Skinner, Tolman, etc.). He was unable to respond to my inquiry of how does behaviorism deal with the effect of childhood experiences on the adult’s behaviour (which I got him to acknowledge first). His answer was ‘this is not  not psychoanalysis but is psychotherapy’.

I heard more analysts over the years say that same thing to anything that did not come from an analyst, as if the criterion of what is psychoanalytic has no distinctiveness quality of its own but is given that quality by the speaker. Psychoanalysis gave birth to psychotherapy but failed to maintain its uniqueness amongst the other psychotherapies. Confusing psychoanalysis with other psychotherapies was product of psychoanalysts’ gradual leniency with its parameters and some mild unnoticeable additions to its basic premise that are core issues in psychotherapy. For instance, Kohut added to psychoanalyzing the notion of empathy and vicarious insight. Doing that changed psychoanalysis to a psychotherapy because it made it dependant and aimed at something not constituent of the process of analyzing but specific to certain therapeutic actions. The lack of defining the difference of psychoanalysis from all other therapies was or the failure of acknowledging its existence makes an uncomfortable duo of a unique psychotherapy and all other psychotherapies.

The protocol of psychoanalysis is very important in distinguishing psychotherapy practiced the psychoanalytic way, and all other psychotherapies, even the presumably called psychoanalytic psychotherapy. The protocol defines the boundaries of what is psychoanalytic and what is psychotherapeutic.

A Fundamental Difference: Method and Substance.

In my opinion psychoanalysis is the practice of psychotherapy with strict adherence to the principles of the protocol. Better, adhering to the principals of the protocol makes the practice of psychotherapy psychoanalytic. The protocol is not a method of psychotherapy; it is the substance of its psychoanalytic practice. That substance is free association and interpretation. Free associating is impossible, because the patient cannot freeze consciousness completely thus what he says is transcended by unavoidable conscious functions. The struggle to say whatever comes to mind without modifications, and not being able to do so reveals that the supposedly free association has more than one meaning. This kind of material requires interpretation exactly as the ‘word of God’ caries the meaning that he wants declares as his commandments but we find out that he was saying something else than what we heard the clergy telling us. Interpreting what the patient says reveals what he unintentionally revealed in his ‘not real free association’.         

Psychoanalysis is only an act of psychotherapy when it is done with the Freudian protocol as its framework. I fined Freud’s outrageous violation of his great clinical insight (analysing his daughter) to be the convincing fact that the psychoanalytic protocol is an absolute element in any proper psychoanalysis because without it we cannot get to the unconscious material that would deserve analyzing.

To put this the practice in context we should review the stages psychoanalysis went through to reach this point. In a first stage hypnosis was used to freeze any conscious judgment, then confront the patient with what he said during hypnosis, i.e. informing the patient of what he does not know was the therapeutic aim. However, Freud realized that the unconscious reveals itself even in ordinary conscious interactions and was able to decipher it without hypnosis. So, psychoanalysis was done, while the patient was fully conscious of the analytic process, witnessing it happening. This change was the first definition of psychoanalysis as a unique psychotherapy; the analyst does the analysis and the patient does the therapy.  The third stage was following interpretations by reconstructing consciousness with the additional interpretations that revealed the unconscious. It is conceivable to see now that the protocol that demands excluding the analyst from the material (not the process) makes the analyst the proper subject of transference, and the analytic material would get its meaning from the lived experience with the analyst. In psychoanalysis, transference is not merely different analytic material but the method of doing analysis: it is the substance of psychoanalysis.  The unconscious material- or the past- resists being forgotten but is still difficult to remember. It is usually enacted in disguised transference acts and thoughts. Transference is the only possible and available medium for the analyst to reconstruct (reorganise) the past and give the patient a better narrative of his life story.