Does the Psychoanalyst Have a Unique Professional Identity? Discussion of the Paper by Michael Parsons
by Marilia Aisenstein
26 th Standing Conference on Training on ‘The Unique Identity of the Psychoanalyst’
Does the Psychoanalyst Have a Unique Professional Identity?
Discussion of the Paper by Michael Parsons
Dear Michael Parsons,
You began your paper with a metaphor taken from karate. Some years ago I myself entitled an article on the psychoanalyst’s identity outside of the analytical situation: `From the Art of Archery to the Art of Psychoanalysis’. You mention a karate master; I was interested in the master archers who also practise the art of philosophy.
I felt that the metaphoric community between us was auspicious for today’s debate, for, even if we should happen to exchange arrows and blows, it would be in the `good spirit’ to which our Far Eastern masters aspired.
Towards the beginning of your report you speak of the psychoanalytic practitioner’s creative identity: while he must be a competent technician, he cannot content himself with that. Indeed, I think one should speak of `artists of psychoanalysis’ in the same way as `artists of archery’ are spoken of in Japan.
The perfect technical mastery of their art was only a means to achieve an inner development which, in turn, was reflected in their knowledge. I shall quote but one phrase by a Zen specialist from his book Zen and the Art of Archery, which says that `by aiming correctly at the target the archer aims also at himself’. This attitude is the same as that to which you refer, Michael Parsons, when you define the psychoanalyst’s professional identity as being grounded in his relationship with his own unconscious. Thus, the practice of analysis is a way of being in which we engage ourselves wholly, entirely.
This definition of identity has implications for training; an interminable training, that penetrates and engages us, that never ceases, imperceptibly, to transform us. If analysis is defined as a process, I think that the psychoanalyst’s training is closer to being a process than to being an acquisition of knowledge. In this respect you quote Klauber who, in the sixties, suggested how to apply metapsychology to the session, and some twenty years later wrote that interpretations spring from the inner freedom of the analyzed, sometimes taking him by surprise. To let this happen, one has to be able to tolerate it, and to wait.
Summing up, I would say that the patient’s working through takes its source from the analyst’s own capacity for working through, i.e., what we in France call `a certain tranquillity with regard to one’s own preconscious work’. I should like to know if you agree with this notion.
I shall now dwell for a moment on your account of the second dream, the one in two parts in which the patient first films a marching army and then perceives a flight of birds… The work you describe seems remarkable to me since you refrained from making an interpretation which was available to you, but which you had the tact to withhold from your patient, choosing instead to let him become aware of his psychic functioning.
This is, indeed, an example of creativity!
And it leads me to the important issue of the difference between psychoanalysis and psychotherapy, or rather the question of the qualification for the practice of psychoanalytic psychotherapy. You write: `I think that only an analyst has learned to trust his unconscious… in the way that enables him to do as little… as I have described, and still be confident that the analytic process will move himself and the patient towards understanding.’
I entirely agree with you and, carrying the argument a step further, I would say: One must be a very experienced analyst in order to know how to refrain from being one (in a particular situation) and, consequently, able to carry out work as difficult as psychoanalytic psychotherapy. One must master the interpretation of transference, in the strict sense, in order to acquire the wisdom to know how to do things differently as you, for example, have done, and give preference to the patient’s preconscious process.
I shall formulate what is perhaps a controversial idea, that an analyst may choose to practise psychoanalytic psychotherapy or not, but that if psychotherapy is to be carried out, it is imperative that it be done by a true analyst.
Thus, dear Michael Parsons, it seems to me – and it is fascinating – that we in fact share a point of view, but our formulations are at variance. You say: only a true analyst is able to withhold an obvious interpretation on the basis of his belief in the analytic process, implying that a psychotherapist would not be able to do so. I respond: only a true analyst is able to do this; therefore only true analysts are also able to do psychotherapy.
Indeed, this question of psychoanalysis vs. psychotherapy touches upon the very question of the analyst’s identity. For me, there is no psychotherapy apart from that which a confirmed analyst chooses to do. If he is really a psychoanalyst he may decide to practise psychotherapy and be conscious of being a psychoanalyst and not a psychotherapist. My wish would be for no-one to be entitled to do psychotherapy unless he had first completed his training as an analyst. The professional identity of the analyst appears to be threatened by current trends in which this idea is abandoned and psychotherapists get trained who do not know classical psychoanalysis. These therapists may deviate from a model without knowing it and certainly make indications without knowing how to recognize an indication of classical analysis. I think of a comparison with painting: a very good painter, familiar with all the classical techniques, is able to create abstract paintings that have meaning. Others will say: it isn’t difficult to paint three lines and a circle, but if they have not studied painting or drawing, if they are unable to draw a nude or a still-life, they will never be a Mondrian or a Picasso. There’s the whole difference.
It is therefore essential to be a psychoanalyst in order to be able to use parameters sometimes without ceasing to be an analyst. The psychoanalyst’s identity is difficult to acquire and to define. To my mind, its essence depends on the training combined with the wish. In a paper of mine, subtitled `Passionate interest in mental functioning’, I have described what I think underlies the wish to become a psychoanalyst. But this passionate interest is not enough, we must want to share it with our teachers, our peers, our students, and our patients.
This raises the question which you ask, Michael Parsons, regarding the Lacanian passe. How can what belongs to the realm of creation and passion – to this innermost identity of the analyst – be institutionalized and itemized according to hierarchical criteria?
I personally think that the acceptance of this contradiction is an integral part of being an analyst. Incidentally, it is well known that some Lacanian groups played `sorcerer’s apprentice’. Too much institutionalization presents its own dangers, pre-selection (which we have abandoned in the Paris Society) being one. I think that the wish to become a psychoanalyst should arise in analysis, or resist its analysis, but not precede it. This seems to me an important point for discussion.
To assume and maintain the identity of psychoanalyst is a very long, difficult path on which one has to accept the inherent contradictions of a solitary, asocial, subversive activity, while at the same time submitting to standards and criteria that define a community. It is interesting to note the discrepancy between Freud’s sulphurous revolutionary writings – about his own dreams and his self-analysis, his papers on infantile sexuality, for example – and the terms he uses in his papers on technique (the student of psychoanalysis must undergo an analysis, with an analyst as instructor). This discrepancy, if misunderstood or found intolerable, is likely to give rise to the distortions that threaten our identity.
I think this is closely related to your thought when you refer to an interior state impossible to evaluate according to formal criteria; and yet we must find assurances, even though none of them can give us a full guarantee. A rigorous course of training is absolutely necessary, yet never sufficient in itself to produce a good analyst. Up to this point we are in total agreement. I, like you, believe in a long and difficult training including several supervisions with different training analysts. Group supervision is useful as well; it is a format designed to teach a candidate not only to show his work to a supervisor but also to accept criticism from his peers. One has to identify with several styles of work before one can find one’s own. Like you, I think that theoretical and metapsychological studies are fundamental. But, like you, I think that all these requirements are both indispensable and at the same time in no way sufficient. They are the necessary minimum conditions, just like canvas and colours of good quality, space and light, are the basics for a painter. We must be sure of offering these conditions, this framework, in the hope that it will allow the spirit of analysis to arise.
At this point in your remarkable report you shift from the conditions necessary for the forming of an analyst to the minimum conditions for analysis. These conditions are not reducible to the setting alone: five sessions a week will never in themselves produce an analysis. I am currently seeing a patient five times a week (45 minutes) for a treatment which she herself calls psychoanalysis (she had asked for five sessions, I suggested four), and for two and a half years nothing analytic has ever happened.
However, minimum conditions must be fulfilled for the analytic process to take place. The unity of place is required, as well as the regularity of sessions – three is the minimum, to my mind, to create the necessary repetition that will allow the unusual to emerge, in the same way perhaps as reassuring bed-time rituals allow the child not to fear dreaming.
Likewise, the repetitive framework affords a temporal dimension to the process and no obligation to be efficient. Symptom-relief may be an additional benefit, as Freud remarked. Often the most interesting moment of analysis is when the patient has totally forgotten why he came in the first place, engaged as he is in the process. You gave examples of such cases.
Taking up the question of the number of sessions – a contentious point between us – I have to say that I do not agree with your argument. In regard to the patient, I personally think that our difference concerns the indication for analysis rather than the number of sessions per week. I entirely agree with you that where analysis is indicated in a borderline case, at least four sessions are needed. This assumes that we are dealing with analyzable patients who, however, are at the limit of analyzability, with a poor capacity for working through on their own and who need the support of a firm setting. The patient I mentioned briefly above is a cardiologist from Chile whose parents were reported missing during the political troubles following Allende’s fall. She suffers from a severe type of character neurosis with great narcissistic fragility and depressive tendencies. I would not have thought of suggesting fewer than four sessions; she, however, wanted to come every day, an arrangement that reassures her. I would say that our analysis occurs in the transference, but there is no structured transference neurosis which would allow real analytical work. The analysis helps her to live, but for me it is not an analysis, it is `analytic support’. A `good patient’ with a truly mental defence system and a completed oedipal organization should not, I think, present with a `Monday or a Thursday crust’, for he or she will have used the interval for a piece of psychic work. I am thinking of another patient who said to me recently: If I’d had to tell you this dream yesterday, I would have associated this or that to it, but today I thought that it could also be related to the idea that yesterday was a day without session; she then connected it to the mornings when her father was absent: she behaved differently when she was alone with her mother.
You also speak, Michael Parsons, of the psychoanalyst’s `Monday crust’. I disagree with this view. It certainly is more difficult for the analyst; it would be more comfortable to see a few patients six times a week rather than twice as many patients three times a week. But I do not feel that the analyst’s convenience is a sufficient reason. If a patient can proceed in the same way with three sessions we should not impose four or five on him for our own pleasure. Economy of means seems to me to be an aspect of the beauty of the technique. In the martial arts of the Far East, which interest us both, the smallest gesture for the same result is the one that is preferred.
Do you mean to say that our own psychic work is discontinuous from one patient to another? I don’t experience things this way: from each patient I gain something by which the others will benefit – at least, I hope so.
As to a condensed analysis, which you mention, I have used it according to certain criteria. It is possible in cases of good analytic indication, i.e., in the case of a true mental oedipal neurosis in a person capable of working through and of continuing the psychic work during the separation. An over-night stay in the analyst’s town is necessary to allow the opportunity to dream, and this type of work should be resorted to only if it can be done in no other way. One of my best analyses was done this way, but I have to admit that it was with a very gifted patient. It took her an all-night train journey to arrive on Friday morning; she had a session on Friday evening, spent the night in a hotel in order to come to a Saturday morning session, and then she travelled six hours by train to get back home. She used to say that she was `in session’ from Thursday afternoon till Sunday and I can assure you that she continued her analysis during the remainder of the week without me.
Trying to focus more theoretically on the points on which I disagree, I would say that there are two. The first concerns the indication for analysis. I distinguish between the specific indication for analysis in a true neurosis with a mental defence system and a more borderline indication where the treatment is at the same time a process and a supportive intervention. This does not mean that patients with the first type of disturbance suffer less than the latter, merely that it is different.
The second point refers to the Freudian notion of deferred action. This concept of Nachträglichkeit was frequently used by Freud, who, after 1915, often underlined the word. Deferred action means that experiences or memory-traces undergo a deferred revision at a later date and at this later stage are invested with a new significance or a new psychic efficacy. It must be noted that it was Jacques Lacan who drew attention to the importance Freud attributed to this concept.
The theory of deferred action obliges us to work on the notion of temporality. The most classically Freudian example is that of a second event that confers a pathogenic significance on an earlier one. Thus, this notion which implies a re-arrangement is also connected to the mental defences.
The Freudian notion of Nachträglichkeit (`later re-working’) seems to me to be more complex than the English translation – `deferred action’ – suggests. Is this accidental? I believe that this concept is not sufficiently recognized in the English literature.
I think that in our practice, in cases where the indication is strictly analytic, where we believe in the value of three sessions, we valorize the patients’ capacity to rework experiences `dans l’après-coup’, i.e., deferred revision and working through. In the discontinuous continuity of the analytic process this type of working through assumes its full meaning.
Finally, dear Michael Parsons, I would like to say how much I appreciate your paper and how flattered and pleased I am to be your discussant. Many of our views are similar, on some we disagree; but I am not against the play of attack and counter-attack, especially when the spirit of the martial arts, as the Japanese masters describe it, is respected.
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