Michael Feldman (Londres)
EPF Congreso de Vilamura, Portugal 2005
In 1912 Freud addressed the difficult task the analyst has in ‘keeping in mind all the innumerable names, dates, detailed memories and pathological products which each patient communicates in the course of months and years of treatment..’ In fact, he suggests that as soon as the analyst tries deliberately to concentrate his attention to a certain degree, ‘He begins to select from the material before him; one point will be fixed in his mind with particular clearness and some other will be correspondingly disregarded, and in making this selection he will be following his expectations or inclinations.’ There is a danger, he says, of ‘never finding anything but what he already knows’ Freud, 1912).
He goes on to recommend the analyst should withhold all conscious influences from his capacity to attend, and give himself over completely to his ‘unconscious memory’’. ‘He should simply listen, and not bother about whether he is keeping anything in mind’. Later, he suggested the analyst should ‘Avoid so far as possible reflection and the construction of conscious expectations, not to try to fix anything that he heard particularly in his memory, and by these means to catch the drift of the patient’s unconscious with his own unconscious’ (Freud, 1923).
Some 50 years later, Bion returned to these matters in his ‘Notes on Memory and Desire’ (1967). He begins, ‘Memory is always misleading as a record of fact since it is distorted by the influence of unconscious forces.’ By contrast, he says, ‘Psychoanalytic ‘observation’ is concerned neither with what has happened nor with what is going to happen but with what is happening.’ He suggests that the psychoanalyst’s real world is concerned with depression, anxiety, fear and other aspects of psychic reality whether those aspects have been or can be successfully named or not. He places emphasis on the process taking place within the session, where, as he puts it ‘Out of the darkness and formlessness something evolves.’ It is this that the analyst should be receptive to, and be ready to interpret.
Here, Bion seems to be primarily concerned with the analyst’s state of mind – his need to maintain a particular receptivity, however difficult and even frightening this might be. The point I take from this interesting but strange paper is very close to Freud’s, namely the potential interference in the analyst’s openness to the patient’s unconscious communications that derives from the memories, assumptions and pre-conceptions that occupy the analyst’s mind. Bion suggests that if by steadily excluding ‘memory and desire’, the analyst does become more receptive to the patient’s communications, he will find, in the patient, in any given session, an ‘increased number and variety of moods, ideas and attitudes’. By using his intuition to follow the evolution of the patient’s psychic state within the session, the analyst’s interpretations ‘Should gain in force and conviction – both for himself and his patient – because they derive from the emotional experience with a unique individual and not from generalised theories imperfectly ‘remembered’.
I believe the familiar recommendations from Freud and Bion I have quoted raise important issues. The first has to do with the analyst’s state of mind – the quality of his attention, how prominently his theoretical pre-conceptions figure in his mind, the knowledge he has of the patient and his history, etc. The second, which is contingent upon this, relates to theories of psychic change: what is it most useful for the analyst to attend to, and to interpret, not only to develop greater understanding, but to promote psychic change.
It is not always easy to reconcile the attitude expressed in the recommendations put forward by Freud and Bion, in the passages I have quoted, with an apparently different theory of psychic change that runs through Freud’s writing. Even in 1937 Freud wrote that ‘the work of analysis aims at inducing the patient to give up the repressions… belonging to his early development and to replace them by reactions of a sort that would correspond to a psychically mature condition. With this purpose in view he must be brought to recollect certain experiences and the affective impulses called up by them which he has for the time being forgotten. We know that his present symptoms and inhibitions are the consequences of repressions of this kind: thus that they are a substitute for these things that he has forgotten.’
He goes on, ‘What we are in search of is a picture of the patient’s forgotten years that shall be alike trustworthy and in all essential respects complete.’ In addition to the ‘allusions to repressed experiences and derivatives of the suppressed affective impulses as well as of the reactions against them’ that emerge in free association, the analysis of dreams, and so on, Freud came to recognise the transference relationship as perhaps the best avenue through which access to the early memories, and early emotional connections could be gained, (Freud, 1937). It is my impression, however, that Freud’s primary concern was to use the transference in the service of reconstruction – to fill in the gaps to arrive at a complete picture. He does not seem to have focused on the understanding and interpretation of the interactions between the analyst and patient as being in themselves of importance as a means of facilitating psychic change, as I shall discuss later.
Spillius (2003) points out that in her lectures and seminars in the 1930’s and 40’s, Klein expresses particularly firm views about the fact that the analyst should link the transference to past experiences and phantasies. In her unpublished notes (quoted by Spillius), Klein (?1945) writes, ‘..We must be aware that analysing the relations of the patient to the analyst both from conscious and unconscious material does not serve its purpose if we are not able, step by step, to link it with the earliest emotions and relations.’ In other words, Klein, following Freud, is espousing a theory of psychic change that seems to be contingent upon making detailed (and, I think explicit) links with the patient’s early experiences.
In his important papers on reconstruction, in 1956, Kris too seems mainly to focus on the question of how the recovery of childhood memories is brought about and the dynamic context in which it occurs. He is, however, also interested in broader issues of psychic change, and raises the question of the therapeutic effectiveness of the recovery of memories. He states that ‘It is well known that in this respect our views have undergone important modifications, since the model of hysteria has lost its paramount importance in psychoanalytic thinking. In a subtle way this model has overshadowed psychoanalytic discussions, even after it had lost its value as prototype, i.e. after the introduction of the structural approach in Freud’s work. Since we no longer view repression as the only mechanism of defence, the tendency to measure results of psychoanalytic treatments in terms of ‘new’ memories recovered is… outdated. And yet this tendency seems to linger on, as part of an unwarranted simplification in our thinking. But while it is comparatively easy to state what we no longer hold true, to say what we believe to be true, is a much more difficult matter.’ (Kris,1956b)
Nevertheless, Kris seems to be following Freud closely in suggesting that therapeutic technique is first concerned with the correction of distortions of the life history. He describes the way some patients have developed an ‘autobiographical self-image’, a ‘personal myth’, which has become heir to important early phantasies which it preserves, and to which they are devotedly attached. This autobiographical screen serves as a defensive structure, a secret core of a personality syndrome – serving both as defence and determining the pattern of life. He observed that with these patients, ‘The certainty that things could not have been different, that their recollection was both complete and reliable was…omnipresent…’. He saw the task of the analyst to ‘pierce’ the autobiographical screen, to discover contradictions, distortions and omissions. ‘Only after omissions have been filled in and distortions have been corrected, can access to the repressed material be gained,’ (Kris, 1956a).
(I would like to add, in parentheses, that there is always the danger that the analyst too, may develop a kind of ‘personal myth’ – a version of the patient’s history, or a picture of the analysis, or both, that serves his own defensive purposes, sometimes also acquiring a quality of certainty, that things could not have been different. This may serve to protect the analyst and/or the patient from contact with more disturbing anxieties, phantasies and interactions, present in the analytical relationship.)
However, returning to Kris’s paper of 1956, he actually goes on to suggest a more complex task the analyst needs to concern himself with, namely the analysis of the significance of the autobiographical screen itself, with its function as fantasy substitute and the meaning of the fantasies thus preserved.’ Later he writes, ‘The dynamics of memory function suggest that our autobiographical memory is in constant flux, is constantly being reorganised, and is constantly subject to changes which the tensions of the present tend to impose’ (Kris, 1956b).
To restate the classical view of the role of reconstruction, as summarised by Viderman (1974) (quoted by Laplanche (1992)), ‘In Freud, neurosis was a disease of memory; and the recovery of the subject’s history, the re-establishment of a historical pattern broken by the effect of defences, followed by reintegration into a consciousness which had lost essentially traumatic memories or guilty wishes, were required to prove by the effect of interpretational construction that access to the totality of the significant history is not only possible but also within the reach of psychoanalytic technique, and that once this task has been accomplished, we have completed the restitution ad integrum that is the fundamental aim of analytic treatment’
Laplanche also makes reference to an alternative position, which he terms a ‘creative hermeneutic’ one, which takes cognisance of the fact that every object is constructed by the aims of the subject and the historical object cannot escape this relativism. ‘There are no crude facts: there is no experience but that which is inquired into’. Thus Viderman speaks of the interpretation’s invention and creativity. ‘What matters is that the analyst, without regard to reality, adjusts and assembles these materials to construct a coherent whole which does not reproduce a fantasy pre-existent in the subject’s unconscious but causes it to exist by telling it’ (Viderman, 1974). ‘Ultimately, the approach of the psychoanalyst should not differ greatly from that of any scholar: he confronts the data, dreams, memories and associations with the aid of preconceptions without which he would simply see nothing at all,’ (Laplanche 1992).
However, as Laplanche points out, ‘There are, for example the two alternating attitudes that lie behind the successive versions… of the case history of the ‘Wolf Man’. One is the search for factual, detailed, chronological truth about the primal scene. However, he suggests that what Freud is aiming at ‘is a kind of history of the unconscious, or rather of its genesis; a history with discontinuities, in which the moments of burial and resurgence are the most important of all; a history, it might be said, of repression, in which the subterranean currents are described in as much detail as, if not in more detail than, the manifest character traits.’ (Laplanche, 1992).
In this paper, I am going to suggest that in the analytic session it may be possible to observe and describe such moments of burial and resurgence, allowing for the analysis of the enduring anxieties and defensive forces manifested at these moments of ‘discontinuity’.
Returning to Kris once more (1956b), he writes that ‘The study of the interaction between past and present stood at the beginning of psychoanalytic work and has remained alive throughout its development. An interaction it is. Not only does the present experience rest on the past, but the present supplies the incentive for the viewing of the past, the present selects, colours and modifies. Memory, at least autobiographical or personal memory, is dynamic and telescopic. The central role of the interrelation of past and present in psychoanalytic work needs hardly to be justified. The psychoanalytic situation with its stress on partial and controlled regression … is so designed that the borders between past and present tend to be blurred.’
‘…One might say that the analyst watches a reorganisation of forces in the patient’s behaviour and guides this reorganisation by his interpretations. This interaction results in what we usually mean by ‘the analytic process.’ The detailed analysis of current conflict situations and the recall of the past are therefore not accidentally but essentially interrelated, cannot exist without each other. Hence the impression that when the influence of instinctual forces and unconscious fantasies on current conflict are analysed, the reappearance of childhood material may follow spontaneously.’ (Kris, 1956b).
He goes on to say that we have come to ‘understand in greater detail the ways in which interpretations aimed at demonstrating in the patient’s behaviour the survival of deeply repressed largely preverbal impulses can be enriched and supplemented by the recovery of memories.’(my italics). He argues that the effective interpretation, in diminishing the defensive functions, strengthens the ego’s integrative functions. This may allow memories to ‘enter the stream of thought, first in associative connections from which they had been excluded, then they take their place in the picture of the personal past, at which reconstructive work aims.’
‘In speaking of insight, the reaction of the analyst should be distinguished from that of the patient. The recovered memories strengthen the analyst’s conviction, fortify him against doubt and may help him to gear his subsequent interpretations more closely to such points in which the past seems to live on in the present.’
‘In favourable… cases – some historical reconstructions or even the total biographical picture becomes part of the patient’s changed self-representation, and the patient remains aware of the relation of these changes to the analytic material.’
I have quoted from these papers at some length, because I think they illustrate the shift from a more classical view of the analytic process, to a perspective which seems to me very different from one which gives primacy to historical reconstruction. It focuses instead on the functions of the interpretation as promoting the analytic process by strengthening the ego, leading to further integration, which may, in turn, give the patient access to a fuller recognition and understanding of his history. I hope to expand these themes later in the paper.
In an interesting paper on ‘Psychic change and the analyst as biographer: Transference and reconstruction’ Frank (1991) makes the point that, ‘Histories derived from diagnostic anamneses are thus invaluable psychological statements. However.. almost inevitably, ..the transference refutes these initial fables, as convincing as they might seem at first glance’.
He goes on to give the following clinical vignette: A young woman attributed her considerable difficulties to the childhood seduction by an adult family friend, with whose almost daily sexual fondling she co-operated from the ages of 8 to 11, in return for small gifts. She particularly recalled an occasion when she was hidden away, with him, and heard her father calling for her by name. She was frightened, as well as excited, that he was looking for her but couldn’t find her.
Frank suggests ‘Nothing that ensued in the analysis contradicted the fact of these childhood experiences or their destructive, disruptive, traumatic impacts.’ However, Frank writes, ‘following the transference, the omitted central issue of the patient’s childhood, which explained and once recaptured could lead to the resolution of the untoward effects of her seduction, emerged. It was of frustrated passive yearnings for the nurturing mother. In particular, she could not give up her driven, almost addictive, needs for chaotic excitement until she knew of the depressed, lonely, inner void from which it was a desperate distraction. The presentation of the plaintive cry in the screen memory was a displacement and a reversal. In fact, it represented the patient’s unfulfilled plea to her mother for sustenance and love. It was her deep hunger for such nurturance which explained her vulnerability to seduction and its perverse satisfactions. The neediness persisted as disguised and repressed, expressed through symptoms and acting out.’
‘This was the reconstruction as expressed tranferentially and understood, articulated and accepted by analyst and analysand.’ ‘With analysis the autobiography constructed in earlier times is stripped back to its foundations, and its original composition and manufacture exposed to those who would look. There is an opportunity for reconstruction in the sense of a revision approximating the realities of the past, providing also an opportunity for searching examination of why and how one seduced oneself, or was coerced, into such original fiction. This historical exercise proceeds simultaneously with, and is intrinsic in, the therapeutic process’.
‘Once rendered, the value of reconstructions can be gauged in much the same ways as any therapeutic interventions. Particularly important is their impact on the transferential dialectic. The result can be progression and deepening as the door to its affect-laden origins is opened further or a resistance removed. As the memories which have become the analytic experience are construed, so the experiences and meanings between analysand and analyst evolve. Thus the analysis progresses, moving ever closer to the origins of the patient’s identity.’ The evolution of the transference relationship will allow the ‘renunciation of distortions and fixated emotional positions. To that degree the analysand is liberated, able to respond more authentically and effectively to the present as present, rather than as repetition of the past.’
Frank goes on to say, ‘Here we are down to the fundamentals of the ultimate mutative analytic curative process. The evolution of transference has resulted in a recapitulation and reliving of the past; a past to whose unrealities and distortions the patient was still tied in patterns of functions and being, i.e. structures. The mobilised insights, changing self-views, recovered memories, and other deduced historical elements are combined to produce a new view. The adult is now in a position to revisit …. the child whom he or she once was, rather than continue under the spell of that child’s shortcomings and tragedies. The integration provided by comprehensive reconstructions are now those experiences’ organising frames of reference.’
And yet, in my view, this more complex understanding of the analytic process is still ‘overshadowed’, as Kris suggests, by Freud’s view of the central function of the evolution and value of the biographical reconstruction. The transference is seen primarily as a means of gaining access to repressed memories and experiences, allowing for greater integration.
Betty Joseph’s work offers us a perspective that is subtly but importantly different. Although Kris, and Frank (to take two examples) clearly make use of transference phenomena, the nature of the transference, and the interactions between the analyst and patient are not described. Joseph’s focus is primarily on the nature of the interaction between the patient and the analyst, what important elements of the patient’s personality, history and pathology are expressed and enacted between them, in those very ‘moments of burial and resurgence’ which reveal important dynamic movements. Her implicit theory of psychic change gives primacy to the analysis of these processes.
In an unpublished paper on the uses of the past (1996), she points out that the way the patient brings his history, his attitude to the past and how he makes use of it in the analysis can be seen as the enactment of enduring defensive patterns. She describes a patient who ‘Uses his history, what he feels about his past and how it relates to his present outside life to avoid the immediate emotional contact with what is going on in the session – the mood, the shifts of feeling that are, or are threatening to be, aroused. It can become an intellectual exercise and can draw us both into an explanatory discussion so that there are two near equals, the patient and analyst, with the former felt to be in the lead.’ In this case, Joseph points out, how the patient’s history is being relived in his use of his history. ‘When history is lived out in these various ways, without the enactment being understood, it does not amplify our understanding of his past and his development, it becomes the antithesis of understand, or to use a familiar term – it means repeating rather than working through.’
Referring to a case, she says, ‘In this material it is not that any new facts about Mr. T’s past are discovered – all ‘the facts’ I have described are known. But what is not known is their changing meaning to him, – the way he has unconsciously defended himself against the pain of the past, but also the way he has used the past and helped to cause and perpetuate it, and this we can only start to sort out as it is re-enacted in the relationship with the analyst.’
She goes on to say that ‘I am not reconstructing my patient’s history and past from what I am being or have been told, the history is reconstructing itself. I am being asked to play particular roles in the reconstruction but my task is to try to be aware of the ways I am being asked to act and to interpret accordingly, not merely to fit into the role.’
‘There are times when it is very helpful for a patient and analyst to be able to look at some situation that has occurred in the analytic situation and relate one’s understanding of it to experiences in the past and the meaning it now carries. But I believe that the patient needs to be able to maintain sufficient distance from the situation for this to be meaningful. If the patient is caught up in some acting out or acting-in in the relationship with the analyst, real understanding cannot be achieved by turning to the past – he is too deeply involved in the present and interpretations will therefore be saturated with this. If he is too caught up in his past he cannot allow the present, the immediate situation, to reach him.’
Joseph goes further, in asking ‘Why are we interested in the patient’s past, his history? How much do we really need to make links with his past and why?’ She suggests this is partly because of the analyst’s own wish for integration, to get a more integrated picture of the patient as a whole. We can also appreciate the importance for the patient of a sense of integration. The timing and manner of the analyst’s reconstructive efforts will, of course, vary. Joseph goes on to suggest, however, that ‘The useful integration of the past can only be achieved if we start from the present, from what is being enacted, however silently, with the analyst, making connections only if and when they form in one’s own mind and seem to be immediately relevant; not starting from the past and explaining the present and the pathology from what one believes one knows of the past.’
I believe this perspective derives its force from the theoretical assumption that what we think of as historical objects are internal objects, and these can be most fully recognised and understood in the present, through the way they are experienced and lived out. This is closely related to the view that psychic change depends in an essential way on the modulation of the internal forces that maintain the qualities of, and the interactions between the patient’s internal objects. I believe this can only be achieved by the understanding and analysis of the way these internal objects and object relationships are expressed in the present, in the transference.
For the analyst and the patient to form links with the past can feel enriching, giving the patient a greater sense of meaningful continuity. However, in my view psychic change is facilitated primarily through the experience and understanding of some of the interactions in the transference-counter-transference relationship, in the way Strachey (1934) describes in his important study. I believe it is in the detailed exploration of the way the patient’s anxieties, needs and defences express themselves in the moment-to-moment interactions, that some modification of internal forces maintaining pathological structures and relationships can take place. The analyst’s understanding, and his capacity to make links, can, for example, modify the force and the nature of the patient’s use of projective identification. This may, in turn, enable the patient himself to recognise meaningful and emotionally laden connections first in the present, in the session, and then including elements of the past.
Discussion
I suspect some of the debate about the use of history and the value of reconstruction derives from the failure to recognise the distinction Freud made between psychoanalysis as a method of research, and a method of treatment. It is inconceivable that we could feel we understood a patient’s psychology without some knowledge of his early history. I think we still hold on to the belief, expressed at different points in Freud’s writing, that an explanatory interpretation to the patient, based on our views of his history will be therapeutic. This may indeed be the case, and I suspect all analysts do use such constructions and reconstructions in their work. This can provide the patient with an experience of being understood and a sense of continuity. It is often gratifying and relieving both for the patient and the analyst to feel there is a joint task of exploration and discovery related to the past.
However, to remind you, in his paper on The Dynamics of Transference, Freud writes, ‘This struggle between the doctor and the patient, between intellect and instinctual life, between understanding and seeking to act, is played out almost exclusively in the phenomena of transference. It is on that field that the victory must be won….’..’For when all is said and done, it is impossible to destroy anyone in absentia or in effigie. (Freud, 1912, p. 108). Here, Freud is talking not primarily about developing a better explanation of the patient’s psychology, but of a battle. I believe this battle has to do with psychic change, and the resistance to psychic change. The theory of psychic change implicit in this passage is that it can only be achieved when the historical and instinctual forces are manifested, and addressed in the transference.
The analyst’s capacity to recognise, to understand and give meaning to the phenomena that manifest themselves in the transference is crucially dependent on what tentative hypotheses and formulations he has regarding the patient’s history. However, in my view this process does not, in itself, promote psychic change. I believe psychic change is primarily facilitated through the detailed work in the transference relationship, where the analyst tries to make meaningful links, for example, between his interventions, the emotions and phantasies evoked in the patient, and the patient’s subsequent verbal and non-verbal responses. The analyst’s capacity to recognise, tolerate and work through some of the ways in which the events of the session, as well as the events of the past are enacted between the patient and himself, gives a sense of continuity and meaning. This in turn may help the patient himself to make meaningful links first in the present, within the analytic framework and the immediate history of the session, and then to relate to elements of the past – to reconstruct for himself a greater sense of continuity and meaning.
To recapitulate, it seems at times that Freud writes as if he believed the primary task was to fill in the gaps, undo the distortions, and finally to arrive at the ‘true’ narrative of the patient’s history for him, or with him. There is something important in this notion of the patient being able to arrive at a more complete and better knowledge and understanding of his history. Such knowledge can diminish the unconscious pressure to repeat and recreate aspects of the history in the present.
However, as I have mentioned, Laplanche suggests that Freud’s more profound aim was a kind of ‘history of the unconscious, or rather of its genesis; a history of discontinuities, in which the moments of burial and resurgence are the most important of all; a history…. of repression, in which the subterranean currents are described in as much detail as, if not in more detail than, the manifest character traits.’
The factors leading to this ‘repression’ may have been particularly prominent at a certain stage of development, and have given rise to enduring distortions of thinking, of memory, or particular symptom complexes. However, our research has led us to assume that most, if not all of the important elements remain alive and active in the patient’s internal world, and become manifested in the current analytical situation. It is therefore only in a trivial sense that we are dealing with objects, events or issues in absentia or in effigie. On the contrary, in the analysis we are dealing with just those forces within the patient that have led to the ‘repressions’, the constructions or distortions of memory that Freud paid such attention to.
If we are now able to recognise, understand and address these processes as they manifest themselves in the transference – the way the patient’s impulses, anxieties and needs construct and change their experiences within the session, we may be able to engage the patient’s ego in recognising and understanding. The hope is that this in turn will lead to a diminution in the force of the ‘repression’ – the projections and distortions that contribute to the experience of what is happening in the session, what has happened earlier in the session, or in the previous one, and, in turn, the patient’s more distant history.
The diminution in such force enables the patient to make connections which he was previously unable to tolerate – initially, and perhaps most importantly in the present, as well as in relation to the past. This can allow the patient can achieve a greater sense of the presence of an organic history with meanings and connections. I suggest this process comes about through the analytical process modifying the internal forces that have interfered, and continue to interfere with the patient’s capacity to make connections, to discover and tolerate the meaning of what emerges, himself.
Michael Feldman
British Psychoanalytical Society
Bibliography
References:
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