Psychoanalysis:Technique

The basic method of is interpretation of the analysand’s unconscious conflicts that are interfering with current-day functioning — conflicts that are causing painful symptoms such as , anxiety, depression, and . Strachey (1936) stressed that figuring out ways the patient about the analyst led to understanding what may have been forgotten (also see ’s paper “Repeating, Remembering, and Working Through”). In particular, unconscious hostile feelings toward the analyst could be found in symbolic, negative reactions to what Robert Langs later called the “frame” of the therapy — the setup that included times of the sessions, payment of fees, and necessity of talking. In patients who made mistakes, forgot, or showed other peculiarities regarding time, fees, and talking, the analyst can usually find various unconscious “” to the flow of thoughts (sometimes called free association).

When the patient reclines on a couch with the analyst out of view, the patient tends to remember more, experience more resistance and , and be able to reorganize thoughts after the development of insight — through the interpretive work of the analyst. Although fantasy life can be understood through the examination of dreams, masturbation fantasies (cf. Marcus, I. and Francis, J. (1975), Masturbation from to Senescence) are also important. The analyst is interested in how the patient reacts to and avoids such fantasies (cf. (1994), The and the Analysis of Defense).[25] Various memories of early life are generally distorted — called them “screen memories” — and in any case, very early experiences (before age two) — can not be remembered (See the child studies of Eleanor Galenson on “evocative memory”).

Variations in technique

There is what is known among as “,” although throughout his writings deviated from this considerably, depending on the problems of any given patient. was best summarized by Allan Compton, MD, as comprising:

  1. instructions (telling the patient to try to say what’s on their mind, including interferences)
  2. exploration (asking questions)
  3. clarification (rephrasing and summarizing what the patient has been describing)
  4. confrontation (bringing an aspect of functioning, usually a defense, to the patient’s attention)
  5. dynamic interpretation (explaining how being too nice guards against guilt, e.g. - defense vs. affect)
  6. genetic interpretation (explaining how a past event is influencing the present)
  7. resistance interpretation (showing the patient how they are avoiding their problems)
  8. interpretation (showing the patient ways old conflicts arise in current relationships, including that with the analyst)
  9. dream interpretation (obtaining the patient’s thoughts about their dreams and connecting this with their current problems)
  10. reconstruction (estimating what may have happened in the past that created some current day difficulty)

Clearly, these techniques are primarily based on conflict theory (see above). As object relations theory evolved, supplemented by the work of Bowlby, Ainsorth, and Beebe, techniques with patients who had more severe problems with basic trust (Erikson, 1950) and a history of maternal deprivation (see the works of Augusta Alpert) led to new techniques with adults. These have sometimes been called interpersonal, intersubjective (cf. Stolorow), relational, or corrective object relations techniques. These techniques include:

  1. expressing an experienced empathic attunement to the patient
  2. expressing a certain dosage of warmth
  3. exposing a bit of the analyst’s personal life or attitudes to the patient
  4. allowing the patient autonomy in the form of disagreement with the analyst (cf. I.H. Paul, Letters to Simon.)
  5. explanations of the motivations of others which the patient misperceives

Finally, psychological concepts of deficit in functioning led to refinements in supportive therapy. These techniques are particularly applicable to psychotic and near-psychotic (cf., Eric Marcus, “Psychosis and Near-psychosis”) patients. These supportive therapy techniques include:

  1. discussions of reality
  2. encouragement to stay alive (including hospitalization)
  3. psychotropic medicines to relieve overwhelming depressive affect
  4. psychotropic medicines to relieve overwhelming fantasies (hallucinations and delusions)
  5. advice about the meanings of things (to counter abstraction failures)

The notion of the “silent analyst” has been made into negative propaganda against analysis. Actually, the analyst listens in a special way (see Arlow’s paper on “The Genesis of Interpretation”). Much active intervention is necessary by the analyst to interpret , defenses creating pathology, and fantasies that are being displaced into the current day inappropriately. Silence and non-responsiveness was actually a technique promulgated by Carl Rogers, in his development of so-called “Client Centered Therapy” — and is not a technique of (also see the studies and opinion papers of Owen Renik, MD).

“Analytic Neutrality” is a concept that does not mean the analyst is silent. It refers to the analyst’s position of not taking sides in the internal struggles of the patient. For example, if a patient feels guilty, the analyst might explore what the patient has been doing or thinking that causes the guilt, but not reassure the patient not to feel guilty. The analyst might also explore the identifications with parents and others that led to the guilt.

Although single-client sessions remain the norm, psychoanalytic theory has been used to develop other types of psychological treatment. Psychoanalytic group therapy was pioneered by Trigant Burrow, Joseph Pratt, Paul F. Schilder, Samuel R. Slavson, Harry Stack Sullivan, and Wolfe. Child-centered counseling for parents was instituted early in analytic history by , and was later further developed by Irwin Marcus, Edith Schulhofer, and Gilbert Kliman. Psychoanalytically based couples therapy has been promulgated and explicated by Fred Sander, MD.

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May 17, 2008 | Filed Under Psychotherapies 

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