2. A Different Way of Saying the Same Thing

 

C. Training to Practice of Psychoanalysis:

 

The second arm of the formation of  psychoanalysts is ‘training to practice’. This aspect of preparing the new commers to the profession is concentrated in two activities: personal analysis (get analysed) and supervision (get the know[aF1]  how to conduct a psychoanalytic treatment of patients from three ‘training analysts’). Personal analysis is supposed to be ‘experiencing’ the process, or as Freud said it in 1910: “…. and ‘derive’ from it the essence of doing psychoanalysis”(SE, Vol XI). Sadly, this part of training lost its didactic meaning and gradually acquired a therapeutic  meaning. This is sad because we know that analysis as therapy does not work if it is not meant from the beginning to be just for therapy. Therefore, personal analysis is a distorted item in the preparation of the candidates. It is -in fact- detrimental to the process of training if it remains as a therapeutic necessity.

 This change had two very detrimental consequences: The candidate does not pay attention to the process, but very subtly creates another objective to replaces the original one(training). The training analyst takes the attitude of a therapist and the original purpose, thus, distorts the  transference and counter\transference. It is a glaring cause of the  psychodynamics of relationships in psychoanalytic societies. Moreover, personal analysis as part of training becomes another source of good patients for the training analysts; not only this does not serve its basic function, but it also distorts the purpose of becoming a training analyst. This aspect of training was the logical way to do training in the early years of psychoanalysis (Eitington modality)but now and maybe in the last seven- or eight-decades training should have taken a different direction. Personal analysis has to be redefined, or recommended as  therapeutic case by case, or be required a suitable period before engaging in a training program.

When we come to the second aspect of training, i.e., supervision, we have to consider that aspect the most basic and fundamental in the whole process of the formation of the analyst. Most the colleagues I trained with and the candidates I supervised had a strong conviction that psychoanalysis (as a process of therapy) has very limited rules, compared to the spontaneity and the analyst’s’ intuitions, and his ‘free floating attention’. I believe that conception, first of all is wrong. There are rules to listening, discerning the unconscious in the rhetoric, interpreting it, or waiting longer before doing that, etc. Because those aspect of training are important the training analyst should know how to explain them to the candidate, so he would practice something that has a theoretical base (the gap mentioned above). What is meant by that is to explain to the candidate-from the material the patient has delivered- what was unconscious in the conscious rhetoric.

Freud’s Tripartite Recommendations:

I believe and advocates the notion that Freud was intuitive about the very basic and cardinal in psychoanalysis but did not articulate his intuitions properly and many time he did exactly the opposite of his recommendation. The reason- I think- is the analyst’s intolerance of putting his identity on hold to maintain neutrality. If psychoanalysis is a unique way of psychotherapy, it is because of Freud’s tripartite recommendations for practice and the analysis of transference, or the transferiantial elements in the relationship with himself.

Freud’s paper on Wild Psychoanalysis  came two years before his three recommendations or the tripartite rules of practice [I believe that Freud’s poor clinical record is due to not adhering to  his own recommendations). His intuition about psychoanalysing made him recommend: Abstinence, Anonymity, and Neutrality. From the patient side he should create his own ideas, phantasies, collect whatever fact he could get or like to get. From the analyst side he should refrain from denying or confirming to the patient any of those notions he built. As for the analyst his unconfirmed or undenied personal qualities- given to him  by the patient- widen the field of the patient’s transference. Two decades ago, there was major attacks on this protocol, especially in Western US Psychoanalysts. The fallacy of the  reasons given shows in analysts extending those violations of the rules of psychoanalysis-unnecessarily-by sharing with patients their own personal thoughts and feelings. The issue with Freud’s recommendations is the need for good personal analysis and understanding of the process of treatment.

The basic ‘idea’ in psychoanalyzing-therapeutic or didactic- is to limit the factual and encourage the personal and transferiantial. So, the natural thing is to explain to the Candidate the logic of the tripartite recommendation and the notion of wild analysis issue. Conducting analysis that way is didactic in itself, whether in training or just ordinary practice. In training the candidate will make the distinction between therapy and learning about the way material gets it wider meaning by interpretation. A training analyst is not a better psychoanalyst but a psychoanalyst who KNOWS how to link interpretations to free association without being obvious in this didactic work. The candidate is not better than a patient in analysis. However, he has the advantage and the duty to learn how the unconscious keeps forming and changing with its interpretation. This knowledge is what to keep in mind all the time while practicing.

 

The Core Meaning of Training in Psychoanalysis:

Freud said clearly: “It is not enough, therefore, for the physician to know a few of the findings of psycho-analysis; he must also have familiarized himself with its technique if he wishes his medical procedure be guided by a psycho-analytic point of view. This technique cannot yet be learned from books, and certainly cannot be discovered independently without great sacrifices of time, about, and success.”(1910, S.D., Vol. XI, p.226). In a nutshell,  the analytic situation is a patient who knows what he suffers from but does not understand the factors that causes that condition. On the other hand, the analyst knows something about the causation of the complaint but does not know the conditions that led to that complaint. Analytic work is to make and engender knowledge to help the other person in that due understand. Therefore, training in psychoanalysis is to learn how and what is involved in this mutual effort to know what seems to one very baffling while for the other (the analyst it is a slow process building up that knowledge. Training in psychoanalysis is to learn how to mange ‘the unconscious ‘knowledge’ of the patient.

This point is related to the meaning of the unconscious knowledge and how the candidate learn to hear it within the conscious rhetoric.

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2. A Different Way of Saying the Same Thing

B. Learning Psychoanalysis:

The literature of psychoanalysis is immense and claiming that some of it are better than others is a foremost understatement. Nevertheless, I have to say something about that: a training endeavour has to do things: make a good choice of literature that makes it logical and easy for the candidates to fill the gap between theory and practice. It does not make sense to have a syllabus that mixes literature from two clearly different authors, or that has samples of the literature of different schools of psychoanalysis. The other point is making the same deliberate choice of Freud’s works. The really significant in the Freud S.E. is how he coined his terminology and how they were pregnant with the rich meanings that they have now. THIS WHAT I MEANT BY AN ACADEMIC SCRUTINIY OF TERMINOLOGY. Our vocabulary was a marvel when it was used in the psychoanalytic theory…new, revealing, full of a variety of meanings. With time (more than a century) it no longer has those qualities and lost anything that give them that insightful  distinction.

     Learning psychoanalysis is easy to identify as sudyining some foundational theoretical texts, but the important aspect in learning the literature is how the chosen literature is studied. Because psychoanalysis is originally an original way of perceiving and understanding common issues and giving more meaning to regular vocabularies a basic part of learning it is to be exposed to those specifics of psychoanalytic way of thinking. The good example to that distinction I am making about learning analysis is the difference between a thinker like P. Ricoeur’s understanding of ‘interpretation’ and Lacan’s style of interpretation. The difference is something to learn.

Therefore, the efforts to update psychoanalysis, theory and practice requires a serious and sharp attention to the gaps between theory and practice and how the candidate will bridge that gap.

   

 

A Different Way of Saying the Same Thing

 

1.Overlooking a Basic Link in Psychoanalysis:

Saying something more than once when that thing is important and needed emphasis or was not understood well enough to leave it alone. I am repeating a previously emphasized idea that ‘psychoanalysis’ is a term that could connote a body of knowledge, and also a specific modality of psychotherapy, but not both at the same breath. The main issue in that distinction is the link between what is usually named the theory of psychoanalysis and what is considered a technique of psychotherapy. Those are two different things but linked. That link is a most elusive subject to agree on its nature. My view of that link is that if there is a link (which I believe there is) it has to come from a well-defined, verified, clearly articulated theory, so the analyst would not practice psychoanalysis arbitrarily. He has to adhere to his understanding of psychopathology and therapy, and how one determines the other. If the analyst understand psychopathology as the outcome of intrapsychic distortions that were formed during growing up his approach in therapy would be concentrating his work on transference manifestations that will give him the insight about those distortions and what to do[aF2]  the reformulate their structure. If the analyst believes that he can deal with the interpersonal mismanagement of the psychopathology, he then will not bring transference in the work and concentrate on correcting the patient’s views about relationships. Each approach has clear distinctions in terms of what to do and what not to do.

Those two different understandings of psychopathology and its link with psychotherapy goes back to something in the Freud’s dealing with discovering ‘psychoanalysis’. Freud began the notion of psychoanalyzing with-maybe-some general social ideas about sexual frustration as a possible causation of hysteria emanating from common social attitudes and some remarks from physicians who must have encountered issues related to sexuality and morality in their daily medical practices.  Hypnosis showed him that he could make his patients talk about those frustrations in less reservations. However, he was able -due to his special psychological sensitivity- to hear double meanings in what patients were consciously relating to him. Talking did not just revealed ‘the unspoken about’ but also unconscious ideas that were implicit in what is spoken. The rest is our history. Freud was endowed with certain mental gifts in addition of great and advanced psychological familiarity with the neurological foundation of most of his discoveries in in psychotherapy (see the “The Project”, and Holms extrapolations). However, Freud noticed and intuitively knew what should be done with listening to the patients’ free associations. In 1912 he made the clear recommendations of a practice of good psychoanalysis; the three or the four (1910) restriction on practice. Nonetheless, he was the biggest culprit in breaking his rules (analyzing his daughter!!). In other words, Freud discovered the core qualities of the real and true psychoanalyzing but did not follow them. He was not a good clinician, but he discovered clinical work that matches his theory[aF3] . He dropped hypnosis and started ‘psychoanalyzing’ the patients’ speech. The link between what is said and what was ‘not said’ but relayed to Freud created that gap between psychoanalysis and psychoanalyzing.  

  However, the gap is very clear in the huge difference between his building of a body of knowledge about psychopathology and psychodynamics on one side and the technique of psychoanalyzing (practice) on the other. The gap between Freud’s clinical work and his knowledge of the subject of psychoanalysis remained a trademark of psychoanalysis as a whole and its literature, since then. The scarcity of clear and committed literature to how we do psychoanalyzing-practicing it- is the background of all the unresolved issues regarding the so-called theories of psychoanalysis (the schools). It is obvious that all the well-known schools of psychoanalysis that were competing for dominating it were related to its practice and not to new knowledge; with the exception of Kohut’s self-psychology. He killed it early trying to find a new way of practicing his sudden discovery of the duality of the subject.

The link between theory and practice looks important as a major issue in the world of psychoanalysis. But it is a link in every individual practice of psychoanalysis. A psychoanalyst who has his patient on the couch or on a chair in front of him has to keep in mind that he is obligated to keep the distinction between his understanding of what the patient relays to him and his response to it, should bridge that gap properly and in the proper moment. The link between his theory of psychopathology and psychotherapy will determine his response, from silence to reconstruction. This means that the practice of psychoanalyzing should always be based on the link between the two connotations of the term psychoanalysis. In other clearer way: the link between what we know and what we do with what we know is where a clinical psychoanalyst has to keep in mind all the time and readjust his work to make that link a daily obligation.

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A responsibility we are supposed to carry:

In a second reading of Solms book it became clear to me that we psychoanalysts were or are not keen to advance our science or profession. We kept recycling old ideas and trying vainly to adjust and readjust some theoretical novelties, but we could only use the terminology that those the novelties introduced. The novel approach Solms has taken to study consciousness could actually lead to solving the issue of the unconscious and makes it clear. We need that because we should work on our difficulties, not leave it to others to solve for us. Just as sample: We know that the unconscious material comes in the forms of metonymy and metaphor, and what is unconscious is not a return of the repressed but a reformulation of what is conscious which happens outside the conscious mechanisms of expression. Solms is putting conscious in the core of our sense of being, thus the unconscious is related to the subject’s sense of being. My slip of the tongue or my transference say something ABOUT ME not hiding something of me. The conscious is only conscious relative to something unconscious (out of my sense of being) . Therefore, psychoanalysis is not making the unconscious conscious but making the subject own both of them as  his subjectivity. Missing a session does not have a meaning outside the patient’s recognition of himself in that missing. Analysis is analysis of the subject and not his expressed speech.

 

Analysis of the Subject and Analytic Material:

 

What ‘psychoanalyzing’ means is very important, yet it is neglected, and its literature is relatively not impressive. The immediate response to this query is that we analyze the patient’s free association with the assumption that ‘free’ associating reveals the unconscious. This basic assumption needs to be reviewed because created an attitude that we analyze the human subject in our patient when we actually try to get to the subject through his verbal and mental expressions and presentations. In other words, in effect we analyze the patient’s psychoanalytic material (association, memories, slips of the tongue, dreams, etc.) and not the subject himself. Then comes the question:  what else is the subject but his ‘psychoanalytic naterial’!!

A vignette might help:

A new female patient noticed that that that in coming up the elevator to her session there was a nice-looking woman who usually comes  down from my floor. She just mentioned that casually twice or three times. After few weeks she noticed that woman is not doing that anymore. In a casual way she mentioned that and made the comment that she must have finished her treatment. As she was familiar with the process she did not expect a response from me about her observations.

After a while she noticed the pretty woman coming down the elevator again. She made several remarks and did not get a response from me. The issue became a persistent issue in her analysis. As I was not responding to her disguised curiosity she expressed her thoughts that there must be some truth to her suspicion that there is something personal in the matter. After another period of agonizing curiosity about that woman and thoughts about jealousies she suffered from in different events in her life, I responded by saying that the presence of that woman in her association made her think and talk about aspects in her life that she did not tell me about before. She dropped silent for a while and then gave some confused memories about a childhood family situation in which her mother was unhappy and ended with her parents’ divorce.

Her parents’ divorce and the surrounding events was disclosed in my assessment interview and was not new material. My response to the repeated mentioning of that divorce was basically that there is some link between her thoughts regarding a personal relationship with that woman and the events that led to her parents’ divorce.  I followed that with saying that she is now talking about other people and not only her complaints. The outcome was a fundamental change[aF1]  though in a very subtle way. She was more expressive as a patient talking to her analysts than just ‘reporting’ things to him about herself., Put it another way: she became a living subject taking about a lived life; instead of a patient reporting a neurotic existence to her Shrink.

The idea is that in psychoanalysis we analyze the patient, i.e., the subject that appears to us in his associations. However, we should always consider that what we hear has to be interpretable to the subject who said them. In a different way, the subject has to relate what we interpreted to his own associations. Most of the time (in my experience) analysts depend on the way the theory of psychoanalysis understands the associations[aF2] . This kind of interpretation is not therapeutic interpretations because it misses the obvious fact that the patient is going to take it back to his own ‘theory’ of it.

If we remain on the level of interpreting the patient association we would not be doing psychoanalysis because we aim at restructuring the intrapsychic condition of the patient. We should be keeping that in mind when we do in interpreting because what we interpret has to be re-constructed. Therefore, the process of reconstruction has to be clear in the “consciousness’ of the subject. In other words, the associations are our windows to the nature of the subject’s intrapsychic structure.

This patient was not telling me what she thought of me as a professional; instead, she created a painful scene from her life that was not fully worked through. Transference is the return of the repressed but with the implicit meaning that it is in a ‘lived moment in the analysis. Analysis of the patient’s childhood experience is not the analysis of remembering it. Analyzing a remembered experience is very different from analyzing a transference event. Analyzing the patient’s memory, is not as analyzing the patient himself. Solms’s subject is a livening human event and not a representation of a subject.

 Interpretation as a Step Toward Reconstruction[aF3] :

The most important thing in our continuous questioning of psychoanalysis is missing the difference between A. Theory and Practice, B. Learning and training.

Theory and Practice:

Psychoanalysis began as a practice looking for a theory. This is the reason we are very much lost when it comes to the theory of psychoanalysis. I will dare we say it: We do not have a theory of psychoanalysis because we refrained from recognizing or realizing that “psychoanalyzing” is endeavored to discover the subject, and every subject is a theory in his own right. Thus, a theory of psychoanalysis should be a theory of the subject (See Solms). The practice of psychoanalysis is a different issue: it is the way we listen to patients giving us a picture of their intrapsychic dynamics and the way make them have a look on the way they are psychological structured with some help from us to add to their effort to change themselves. This is the work on -interpretation-reconstruction (base on the discovered subject). 

 

Learning and training is more of a political issue than I naively though thout at the beginning. So!!!!!!!

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The Next Step Before the Last.

I was intending to write a post on the narcissistic base of patriotism. The main notion is that we naturally react negatively to all kinds of narcissism. With narcissistic patriotism we seldom react so negatively, as if patriotism regarding one’s country is natural and unquestionable. However, narcissism it the core of any identification of which nationality is a prominent one. There are some aspects in identification that could go astray when the subject of the identification is badly chosen. Psychoanalysis could initiate that kind of stupid narcissism that stupid patriotism could also create.

Reading Mark Solms’s last book “THE HIDDEN SPRING” made me change my mind. I went [aF1]  back to an old disliked if not even hated subject: “Is old or even currant psychoanalysis still useful!!!!

Solms’s thesis takes us to a new start for the understanding[aF2]  of the Freudian thesis; no wonder he was dedicated to revising the English (official) translation of “The Standard Edition of the Complete Works of Sigmund Freud”, which is due to appear this year. Although this is a separate issue it raises many points: do we know what to do to update our theory! Do we think that Freud’s text is a ‘passee’ issue and we should not be rereading it but concentrate on the more recent works of the new generations of analysts instead? Is it a better translation of Freud’s able to change anything regarding our present attempts at modernizing psychoanalysis?

First, Solms’s book is a very serious attempt at creating a new psychoanalysis. It is based on recent findings regarding neuropsychology which astonishingly corroborates Feud’s first publication (The Project, 1895). Solms’s neurological discovery and integrating it in the whole context of Freud’s Text with the notion of giving the Freudian text its veritable meaning. He is changing  the idea that we have one psychoanalysis and that it is  the present psychoanalytic situation.

I think there are[aF3]  an elephant and two monkeys in the room: Solm’s new translation and what was behind that request. After almost seven decades, of The Standard Edition: do we need verification and explanation of psychoanalysis? The monkeys are: what is missing or flawed in psychoanalysis as it is thought of now[aF4]  and required revising? The second monkey is: are we really going to reread Freud to qualify as psychoanalysts[aF5] ?

It is useful to make a distinction between the SE. as the source of the psychoanalytic vocabulary and as the psychoanalytic grammar.  Something we should underline; although the SE remained the undeniable index of Freud’s work and translation, the European translations of the body or the works of Freud corrected the foundational mistakes in the English Edition. I will get to that later but for now I want to address this issue: what we have been practicing till now in the English-Speaking world was not totally the real Freudian psychoanalysis. Most the established analysts will reject this idea vehemently, however, there are very important woks about this point in English (Laplanche, Bettelheim, which brought to the attention of the “Anglo” analysts the distortions in the SE.

 The notions I will mention (to follow) will be just unmasking the second monkey in the room. Psychoanalysis is psychoanalysis as a verb and not nouns or adjectives. As an example: dealing with Trieb as a thing (instinct). and not as a pressure put on the mind to make the subject act turns psychoanalysis into a theory of functions not an act of analyzing structure. The evolution of Freud’s work attest to the progressing unmasking of the human subject.

If all that is gibberish have the freedom to say I like psychoanalysis as is or I will go to a new notion of psychoanalyzing.

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Freud’s Intuitive Discovery of Psychoanalysis and the Essential “Classical” Rules of Practice.

I expect that neurological, neuropsychological, and psychoanalytic discoveries will ultimately reveal a link between intuition and the unconscious. By knowing how to analyze such link it will be possible to answer this question: Do great thinkers uncover what they discover about the human subject and human nature by intuition or do they unconsciously sleepwalk to their great thoughts. Did Freud discover psychoanalysis intuitively or through a process of organized thinking? The differences in answering this question could help us decide if psychoanalysis is something that has to be taken the way Freud proposed it with minimum elaboration, or we could take it as a starting point in a progressive process of thinking.    

There is something about the start of psychoanalysis that forces that question on us: Why did Freud start so early in his psychoanalytic journey by thinking and working on the proper conditions of practicing it (1910,1912)?  Did he intuitively foresee that there are surprises awaiting us if we followed him in the path to therapy? Or did he anticipate that practicing psychoanalysis will lead to more than just replacing hypnotism with free association?   

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In a previous publication (‘Understanding Classical Psychoanalysis,2017) I underline the great intuition that Freud had to standardize the practice of his new discovery, ‘psychoanalysis’. In my opinion then, and now, a profession based on listening to a person speaking about himself in order to lead patients to change their intrapsychical dynamics has to be done in a consistent predictable environment, and treatment has to be decided only by achieving its success within that unchangeable protocol. This is not the familiar medical model of therapy in which the physician is the one who decides about the treatment. Standardizing the conditions of doing psychoanalysis was Freud’s ‘intuitive’ work on the patient’s disclosures. They have to be derived from within an identical process of work, with very limited external interference and variations that could affect the analyst’s unfolding of the unconscious aspect of the patient’s self, as well as affecting the analysand’s gains of insight. There was also the requirement of maintaining a necessary distance (mild in the case of the patient) between the patient and the analyst. Freud’s tripartite protocol for doing psychoanalysis and the regularity of the patient’s sessions added to restricting analysis to what the patient says about himself formed the criterium of the correctness of the analytic process.

The rules of practicing analysis, which were inherited ‘blindly’ up till now, were founded on the available knowledge of what psychoanalysis was, then. I have to add that early psychoanalysis and most of current points of view are basically of functional nature (causes like deprivations and effects like reaction formation, etc.), which limit or eliminate the uncovering of the intrapsychic psychodynamics which is the forming influence of the psychopathological condition.

There was an underlying tendency to use the new vocabulary improvised by new discoveries as theoretical background of an advancing psychoanalysis. But the main trend was to make psychoanalyzing an act of ‘making sense’ of the psychoneurotic conditions, assuming that this ‘making sense’ is the curable factor.

Things have changed overtime: in the first place we know now much more about the structures of psychical phenomena.. We also know that obvious functional understanding of psychological manifestation is more likely to be misleading and limiting of the analyst’s field of work. Moreover, we deal now with much more healthy patients- in terms of the old criteria of pathology, which makes our work in need for serious revisions of our blind rules of practice. Thirdly, we should have realized by now that the practice of psychoanalysis as therapy is related to the intrapsychical structures of the patients and not about pressures, deficiencies, lacks, deprivations that still demands satisfactions, etc. The rules of psychoanalysis that we followed till now in terms of the number of sessions per week, the length of time of a session, duration of therapy for cure (or training), couch, vacations, etc., were arbitrarily established in the past, and were chosen to fit the analysts’ professional needs (not the patient’s requirements).

In other words, the rules of practicing psychoanalysis did not come from the patients’ need or from understanding what psychoanalysis is about, because there was very little known about any of that till few decades ago. But I assume that we know now what unconsciousness versus consciousness means, how to interpret psychological material and reconstruct interrelated psychical manifestations which changes the nature of our work from receiving the remnants of transference to showing the patient the intrapsychical distortions in his transference relationship with the analyst. We are not automats who just follow a prescribed way of practice; we are supposed to know the psychodynamics of the human subject and the way to deal with them to affect the required changes.

Learning and Training in Psychoanalysis:

The history of psychoanalysis shows that it had to begin with a period of apprenticeship, which lasted much longer than the usual apprentice periods in other professions. Both the master craftsmen and student in psychoanalysis were learning a totally unexplored field of knowledge. However, in a gradual way knowledge about human psyche accumulated and most of the pioneer apprentices turned that knowledge into a theoretical body (though stubbornly most senior analysts wanted it to remain some details of a profession of psychotherapy). By the seventies of last century there was a firm body of knowledge, and interest in that knowledge in neighboring fields of academics, to turn psychoanalysis from an apprenticeship to an academic branch or program. Doing that conflicted with the personal interests of the leading psychoanalysts, or the training analysts. Although that at the present time there are great kafuffles, debates, and complaints about the Training Psychoanalyst status they is a resistance to SEE that we cannot have a training system based on apprenticeship without having master craftsman (A training senior). How could we maintain the model of apprenticeship in training candidates in an IPA and alike institutes without “training analyst”?

Back to the standard rules of practice:

·       The standers rules of practice, which we follow till now, were very useful but were arbitrarily decided then.

·       They reflected an early status of psychoanalysis based on a limited knowledge of what psychoanalysis is.

·       Knowing what we know now about psychoanalysis, as well as

psychoanalyzing (interpretation and reconstructing) demand a review of our practices.

If the notion of a need for a new psychoanalysis is accepted a revision of the practice will come as a natural outcome. If that notion is rejected there will be no need for revising those rules because they will die with the dying psychoanalysis.

Whatever the way will lead us to  the link between the psychoanalysis we adopt and the method we will apply it is not arbitrary: we practice the psychoanalysis that dictates its own method.