A Theory of Technique?!

Yes, a theory of technique, but only if psychoanalysis is acknowledged as a theory of the human subject first, and not only a psychotherapy. Defining the human subject and concentrating on his most distinguished and distinctive characteristic would lead the psychoanalyst to a theory of psychopathology, and consequently to a theory the technique of psychotherapy. A good definition of the human subject comes from his dual nature: I (subjective)\Me (objective), conscious\unconscious, thought\language, issue\meaning. Our psychical life is a creation of our dualities: thus, it is our successes or failures in bridging those gaps will determine our psychopathologies. Those notions of dualities would directly lead us to where the human subject’s psychical life is, and how it could get affected. The first step and the foundation of becoming a psychoanalyst is learning how dualities emerge and what the caregiver does to help the enfant manage them  This point requires more than just mentioning it in the context of a theory of technique.

The subject’s dualities is the product of our neurological evolution and being the only creature, which has the inclination to uses ‘language’ in communication, not signs and sounds talk (Note a five-month baby making vocal sounds when he  sees or hears something which suggests that he ‘recognizes’) . Language, generally defined, as the link between the intrapsychic and interpersonal, i.e., the link between one pole of the duality and  its counter pole. “Language”, in its core is the main link between the subject and the other. But this point needs an explanation.  I am not sure if we have the inclination to develop a sense of identity before  or after the appearance of our dualities, or visa-versa.  Therefore, I would say that psychoanalysis, and only psychoanalysis has the conception that psychoneuroses exist within the link between the intrapsychic and the interpersonal. In other words, all other psychotherapies deal with either the interpersonal or the intrapsychic while ‘proper’ psychoanalysis deals mainly with the link between the two. The distinction mentioned here is not only a formal distinction but also the distinction that makes psychoanalysis the only psychotherapy that aims at cure, not improvement.

That difference between psychoanalytic therapy and other psychotherapies reflects another important distinction in the training of therapist. The theory of the subject in psychoanalysis is based on the unconscious separation of the intrapsychic from the interpersonal, while in other psychotherapies the emphasis is on the interpersonal  as the seat of the problem. Thus, the psychoanalyst has to know (learn, know amount of knowledge in the works of other  scientists of the humanities and other analysts that needs to be ‘studied’ with academics to understand the formation of the intrapsychic and mostly the unconscious linguistic formations of such link. There is a significant scientific basis for what the analyst has to acquire to apply the analytic technique well. In another clearer way: there is a significant link between the intrapsychic and the interpersonal which requires a wide and deep knowledge of child’s development. This aspect is not a matter of apprenticeship or seminars in a training center: it is a matter of a number of years of systematic education with a clear curriculum and a number of specialists.

This leads us to the sensitive issue of personal analysis in the formation of the psychoanalyst. This item in the IPA tripartite training method was originally the only way to learn how psychoanalysis is done (!!??). It evolved for to make Freud come up with his recommendations of Anonymity, Neutrality, and Abstention. Although other formalities  pertaining to the number of sessions  and some clinical rituals evolved gradually, nothing of substance to their psychoanalytic significance was given to them properly to expose their clinical value. Without that requirement a major, major aspect of psychoanalyzing quietly got disappearing: Transference.  

The Psychoanalytic Technique:

I am not sure if  the two separate brain locations of language created the duality of the subject, or it is the other way around (the last book by Solms)did not address this point.  Therefore, I will carry on with the assumption that duality is  a fundamental feature of  the human subject [Psychoanalysis will lose its identity if this point is not emphasized, in spite of its undeniable contribution to all human sciences]. It is not easy to emphasize that issue because since the early forties of last century  psychoanalytic psychotherapy was turned into a “free for all” kind of field, while a theory of technique could not be formulated within a chaotic line of work .  Moreover, psychoanalysts produced a rich and equally jumbled catalogue  of vocabulary that looked (sounds) like component of a theory when it is not more than using common words in an operational background. A theory of technique should emerge from a thermotical background  of psychopathology. In light of the fundamentality of the subject’s duality the theory of technique should come out the psychoanalytic concept duality.

The duality of the subject and the link between the two poles of the duality are the forming elements of the subject’s intrapsychic structure. It is not difficult to have an idea of what is the basic duality in the subject’s  personality from taking a good history and noticing his speech and the issues of importance that constitute  his mind. A preliminary diagnosis of the intrapsychic would lead to reasonable expectation of the patient’s psychodynamics. Further observations of what does not seem fitting in the clinical picture could also highlight the failure in the link between the two poles of the patient’s dualities (most analysist do most of those things unintentionally,  thus they do not benefit well from them). Yet, those aspects of the initial assessment will influence the technique the analyst might keep in mind while working with the patient. An example will fit here:

A female patient who was less than average in her looks was in a relationship  with  handsome and very well-known poet (in Egypt).  At the same time, she was befriending his wife, who was not aware of that secret relationship. As usually happens,  rumors went around, and the affaire became an open subject for roomers and comments. The wife attempted suicide and my patient did not show any sign of remorse or guilt about that incidence. On the contrary, she was (I was told) enjoying the notoriety of the whole matter her. However, she developed a painful and obvious skin condition. Her brother insisted that she comes to see me for a consultation. In the second interview she was talking about the poet’s wife and made a slip of the tongue: she said competition (Monafasa in Arabic) instead of discussion (Monakasha in Arabic). I did not wait- as I usually do- to tell her that this slip of the tongue is coming from things she did not talk to me about in her first interview. What came out of this intervention was a flood of puzzled dualities of ‘good’ and ‘bad’, honorable, and dishonorable, and several other dualities that pertained to morality and immorality. They  came out in almost a gush associated with pain, shame, and despair. She remembered situations in her early childhood at school when she was not accepted, and promising herself that one day, she will have revenge and harm those kids badly.

Hesitating in telling me more about her reaction to the attitudes that followed the scandal of her love affair convinced me that she has contributed to making the secrete become a scandal. Sure enough,  she confirmed that she enjoyed- to an extent- the notoriety. However, for the rest of that interview she was sad that she was not nice looking like other girls, and that affair boosted her sense value and now it has a negative effect on her. I got the chance then to ask her to talk more about her slip of the tongue. She conceded that she always felt that she is in a competition (Monafsa) with others. Her analysis started later to reveal her confusion in regard to competition: the wish to be admired and to be loved. Some issue regarding aggression cam out revealing a major lack of understanding aggression and being aggressed. To get to the point I started this post to discuss I usually start by exploring the field of the patient’s concerns (the main duality that is in need for clarifying) and based on the psychodynamics of that duality I keep in mind the manner that duality was mismanaged in building the patient’s intrapsychic core. In this way, psychoanalysis will have the flexibility required to do a good job while I still  know what I am dealing whatever the analysis deviates to.

What is meant by that is to listen to the patient’s speech in order to find out what is the duality that had the largest impact on the formation of his intrapsychic structure. This is also useful in having an idea of what the transference will be like. After a while of that free-floating attention the features of the pathological outcome of creating symptoms, as the bridging of the gap in the duality, will emerge. What the analyst will do with that is a separate issue in itself, which I believe is unteachable but mostly it is what make us different. The last thing I would mention here is the formation of symptoms. Symptoms are very useful in giving the diagnosis additional verification the patient’s symptom was a psychosomatic skin flare up. Most of  the literature on that symptom (five old papers with very limited value) and my own experience strongly suggest that those skin condition relate to craving for primitive intimacy and very early deprivation of secure contact with the care giver. Symptoms- even if they are only verbally expressed SAY something that could be even verbalized.

To sum up my thesis I would say that a thorough psychodynamic diagnostic work could deal with the a proper assessment of the intrapsychic issues that are expressed in the patient’s character formation, leading to the main symptom (psychopathology) , and that in itself is most valuable guide to the work of interpretation and reconstructing a better functioning intrapsychic.