“What Does Not Change”: Technique and Effects in Psychoanalysis
By J. Todd Dean, MD
What does not change
is the will to change.
—Charles Olson, “The Kingfishers”
In an interview with The Daily Telegraph (Copping, 2008), the British analyst Darian Leader expressed concern about recently proposed state regulation of psychoanalysis thus:
The new system may be OK for people like cognitive therapists, who concentrate on trying to get rid of things like depression or eating disorders in a certain number of sessions, but psychoanalysis does not have such set outcomes. Our approach is that we don't know where we are going to go, or how long it will take, we just have to see what emerges. It is an exploration of one's history that, unlike things like cognitive therapy, doesn't aim at the removal of one's symptoms.
Leader's comments are scandalous in their candor: there is not even a pretense of satisfying the expectations of empirical medical discourse, in which a therapeutic technique is judged to be efficacious based on its ability to eliminate symptoms. To say straight out that psychoanalysis “doesn't aim at the removal of one's symptoms” invites the immediate response of “then what good is it?”
While the proposed regulations were ultimately dismissed by court order (UK Government, 2011), Leader's comments leave questions in their wake that go far beyond the immediate concerns out of which they arose. If “we just have to see what emerges” in analysis, and if the therapy “doesn't aim at the removal of one's symptoms,” then what are analysts doing, and why are they doing it? It is striking that these questions remain so compelling today, over a century after psychoanalysis was invented. What constitutes the profession of psychoanalysis? Is it a technique for a particular kind of therapy, for a particular kind of problem? What effects can psychoanalysis be expected to produce, and how does it produce them? Freud addressed these questions—the relation between profession and practice, technique and effects—early on.
Alarmed by what he saw being done in the name of psychoanalysis, Freud wrote “‘Wild' Psycho-analysis” in 1910. While manifestly a defense of the professionalization of psychoanalysis, this brief article has profound relevance for questions of regulation, technique, and effects. In it, Freud describes a consultation in which a young divorcée sees him because a physician, referencing Freud, has told her that the anxiety that brought her to him would be alleviated if she would either “return to her husband, or take a lover, or obtain satisfaction from herself” (Freud, 1910, p. 221). The patient consulted Freud to find out if he really would make such a scandalous recommendation, which left her feeling hopeless, since none of the alternatives were acceptable to her. Freud devotes the bulk of the article to a criticism of the physician's recommendation, explaining that it was precisely because of such interventions that he was compelled to start the International Psychoanalytic Association (IPA) and to create procedures for certification of analysts. But then, in the middle of the last paragraph, he adds the following:
For as a matter of fact “wild” analysts of this kind do more harm to the cause of psycho-analysis than to individual patients. I have often found that a clumsy procedure like this, even if at first it produced an exacerbation of the patient's condition, led to a recovery in the end . . . . In the case of the lady whose complaint against her physician we have heard, I should say that, despite everything, the “wild” psychoanalyst did more for her than some highly respected authority who might have told her she was suffering from a “vasomotor neurosis.” He forced her attention to the real cause of her trouble, or in that direction, and in spite of all her opposition this intervention of his cannot be without some favourable results. (p. 227)
This comment raises a question about the relation between technical rules and analytic effects. While we could say that the physician's intervention was ham-fisted and insensitive, it at least had the potential of surprising the patient. It might introduce something she had never recognized before—the relation of her anxiety to her erotic life—and this, according to Freud, would inevitably prove useful.
Subsequent commentators, however, are often put off by this ambivalence about rules. Adam Phillips, in his introduction to the new Penguin edition of Freud's papers devoted to questions of technique (which includes “‘Wild' Psycho-analysis”), notes that “when it came to the making of rules, not to mention the testing of them, Freud was curiously unforthcoming” (Phillips, 2002, p. xiii). This suggests that Freud was avoiding the question. In fact, his appreciation of the “wild” intervention suggests that he was not entirely comfortable with rule-making to begin with.
We know from at least one firsthand report (Bernfeld, 1962) that Freud was himself dismissive of “the authorities” of psychoanalytic pedagogy (p. 462). When Bernfeld, in 1922, asked Freud if he thought the novice should have a “didactic analysis” prior to beginning his own analytic work, he quotes Freud's answer as, “Nonsense. Go right ahead. You certainly will have difficulties. When you get into trouble, we will see what we can do about it.” Bernfeld continues, “Only a week later, he sent me my first didactic case . . . . Alarmed by the task and the conditions, I went back to Freud; but he only said: ‘You know more than he does. Show him as much as you can'” (p. 463). These comments suggest that Freud had a much more flexible idea of what analytic technique could be than is commonly supposed. However, they also leave unresolved the question of what it is, exactly, that Bernfeld knows that his patients don't know. One could wish this question were raised more directly and more often than it has been in analytic training.
Jacques Lacan, writing in 1956, expresses concern about Freud's decision to create the IPA: on the one hand, it is understandable that he would want to develop a means of maintaining his thought; on the other, in doing so, he created a new problem: the “tradition and discipline” of psychoanalysis “is to call into question” the “very crux” of tradition and discipline (Lacan, 1956/2006b, p. 397). In other words, by establishing a professional standard, one risks limiting the scope of analytic questioning. This resonates with Freud's limited approval of the “wild” intervention: for both authors, it is necessary that psychoanalysis disturb the status quo ante, whether in a patient's psyche or in the transmission of psychoanalytic teaching.
The whole question of “tradition and discipline,” however, is looked at quite differently by many analysts. Consider Arlow's (1991) commencement address to a graduating class of the San Francisco Psychoanalytic Institute, delivered 80 years after Freud's 1910 paper. It contains an imagined letter to a “Dr. Freud,” whose application for candidacy in the institute is rejected based on his write-ups of four cases: Dora, the Wolf Man, Little Hans, and Schreber. The letter is intended to show how far Freud's work is from anything that would be acceptable in contemporary psychoanalysis. Dora was in treatment too short a time, the Wolf Man was too ill, Little Hans wasn't a real analytic case, and Schreber wasn't a real patient. The point of the letter is that none of Freud's cases follow proper technique; consequently, they are of merely historical interest. Arlow goes on to encourage a “scientific spirit of free inquiry” in psychoanalysis, but, again, this inquiry is to be free only in investigating technique as it exists at the time: it is described as a willingness to investigate “the analytic situation itself,” for example, as he recommends, through the study of a tape recording of an analysis. For such endeavors, the works of Freud are, simply, “our youthful friends, and they served us well; but the time has come for us to get on to other things . . . . Freud's early papers and his case histories are milestones . . . . They are major historical documents, but they do not represent modern psychoanalytic thought and practice” (p. 21).
But how long Dora was in treatment, or how ill the Wolf Man was, are only relevant questions if the impact of those factors on the outcome of a treatment is clear. Though Arlow in fact never says what the assumed outcome is, such an assumption is necessary for his argument; otherwise, how could a criticism of Freud's case studies based on the technique exhibited in them be relevant? It seems clear that what constitutes “modern psychoanalytic thought and practice” for Arlow is a matter of technique: the effects that technique is expected to accomplish are taken for granted. If everything is done properly, the outcome of an analysis is as good as known in advance, not unlike the result of a properly performed coronary bypass: if the thoracic surgeon does his job right, then we know what to expect. Consequently, defining the effects of an analysis is irrelevant to Arlow's concerns—he doesn't mention anything about them. But the problem is that, unlike a coronary bypass, an analysis does not have such an obvious expected outcome.
The fact that Dora was in treatment for a shorter time than would be considered acceptable in an analytic training program today, or that Little Hans was more a supervised case than a patient, does not obviously invalidate the work Freud presented, at least in terms of its use to students. In fact, this would only be a problem if we read Freud's case histories as models of technique, as Arlow does here—models that are now outdated. Similarly, while Arlow dismisses the Wolf Man as “too sick,” Leader (2011, pp. 246–272) has argued persuasively that the Wolf Man's case is of enormous interest to a student today, though not because of its description of technique. The contrast is stark: for Arlow, psychoanalysis is defined by its technique; for Freud and Lacan, technique is secondary to the effects that analysis is expected to produce.
In fact, viewed from a therapeutic perspective, there is a remarkable paradox here. While there may not be an obvious technique or generally expected outcome in analytic work, there is, for Freud, Lacan, and Leader, a theory of cure: psychoanalysis and the psychoanalyst are expected to accomplish something . If, as Freud suggests, the physician's “wild” intervention might be useful, Freud must have some sense of what it is useful for. I would suggest that exactly what that is has not been the subject of very close inquiry in most schools of analytic training, where the emphasis is so heavily on learning a technique—an emphasis that too often takes for granted the question of what that technique is intended to achieve. In fact, candidates are rarely held accountable for what happens in an analysis, only for following a procedure. But in my experience both as a candidate and a supervisor, the very idea of doing otherwise gives one pause: what would constitute the good or useful effects of analysis, and how would one assess a candidate's work from that perspective, especially when there is so little emphasis in training on what those effects are supposed to be?
Arlow's take on what constitutes clinical work in psychoanalysis is characterized by an identification of the observed phenomenon with the question of therapeutic goals, without any consideration of an intervening third term. In his comments on Freud's case reports, the possibility that we would read them for some other purpose than to see what an analysis is supposed to look like is not even raised. That Arlow would be dismissive of Freud's case histories on these grounds should have been more concerning to an analytic audience than it apparently was: do we read any psychoanalytic paper with the goal of finding a model for what analytic practice is supposed to look like? Do we really think that a description of an analytic process, carried out in another language and culture over a century ago, could tell us what an analysis should look like today? It is like arguing that the main reason to read Plato is to learn how to behave like Socrates.
Such a focus creates the risk that the analyst will fall prey to his or her own assumptions about what is happening as he or she listens to the analysand. This is because we are focused more on the job of carrying out the formal technique than on what the process is accomplishing—we are practicing what we already know rather than discovering the unknown. For example, if I assume that everything the analysand says and does is specifically about the transference, then I am going to bring a ready-made understanding of her words to the process. The same could be said of any assumption concerning technique. Freud was himself very clear on this point: what the analyst listens for is always specific to this analysand, at this time. This is true from his earliest work with hysterics: “[W]hen his first hysterical patients enter a state of reduced consciousness and are overcome by hallucinatory experiences, what interests Freud are not these experiences or states themselves, but what the patient says about them” (Van Haute, 2002, p. xxxi). Similarly, Freud does not care, in The Interpretation of Dreams , what “really” happened in the dream, as he makes clear in his discussion of the dream work in chapter 6 (1900); instead, he insists on paying very close attention to how the patient describes it. Even in his last technique paper, “Constructions in Analysis” (1937), he insists that the value of anything the analyst does is determined solely by whether or not it moves the analysand to make new associations. Freud's clinical interest is always on what is said by the analysand, not on achieving a predetermined goal. Again, this is entirely unlike the example given earlier of a coronary bypass: where the surgeon works with an assumption of universal norms—this is the anatomy of the heart, this is its physiology, and this is what pathology looks like—the psychoanalyst works to get to the most idiosyncratic parts of the psyche, what is unique to each subject.
Here we can usefully question the difference between an analytic effect and a therapeutic result . In medical discourse, such as the discourse surrounding coronary disease, all the clinical activity is geared toward a specific, predetermined result: a return to a previous state of health. In analytic discourse, the result is unknown: “we just have to see what emerges,” as Leader told his interviewer. An analytic effect, then, is not the same thing as a therapeutic result. Is there then some more specific way to define the concept?
I believe the best answer to this question follows from Freud's discussions of analytic work referenced above. Analytic effects are unlike other kinds of therapeutic effects because a specifically analytic effect is one of surprise—as in the case of the young divorcée—not symptom relief. An analytic effect creates a new subjective awareness—a new recognition of something that had formerly seemed foreign, but is now seen as part of oneself—rather than a return to a previous state of health. For this reason, analysis is a dialectical procedure unlike any other type of therapeutics. This is because (a) the optimal outcome of analysis is not a given, unlike the optimal outcome of any other therapeutic procedure, where the goal is always to return to the status quo ante, and, therefore (b) the techniques used to reach the end of an analysis are not, and cannot be, given, and are in fact always in play.
Often, an analytic effect is achieved when the analysand's own words and actions return to him, strike him differently from before. We see this in Freud's aside on the “wild” intervention: the subject is surprised by what the doctor recommends, but, as Freud imagines it, comes to recognize in this intervention “the real cause” of her anxiety, thus potentially coming to think of her symptom differently. This speaks to a concept that was central to Freud's work from the beginning: one's self-awareness covers over things that are surprising; what we experience as the self is not representative of the entirety of our subjectivity. The subject is, as Laplanche (1992/1999) describes it, decentered with respect to his ego, always moving between what he consciously recognizes as himself—a sense of himself centered on the ego, the “Ptolemaic” subject—and the subject that is not (yet) recognized as such, that appears always as a surprise. From this we can argue that an analytic effect is, of needs, a disturbance of the “Ptolemaic” status quo of the analysand, neither the achievement of an objective norm nor the valorization of self-awareness. Where this will lead is not at all clear to either party of the analysis until after it has happened.
There is an exemplary debate around questions of technique and effect as these play out in the opening sessions of Freud's treatment of the Rat Man (Freud, 1909). Mahony, in an extended critique of Freud's treatment and report of the case (1986), is unequivocal: it “affords a reliable picture of Freud as frequently intrusive, reassuring, and seemingly more drawn to genetic interpretations and to reconstruction of past events than to the current interplay in the clinical situation” (pp. 89–90). He goes on to argue that a significant element of the transference—the patient being bored into ( erraten ) by Freud's interventions—had a never recognized yet profound impact on the course of the entire treatment (pp. 103ff.). Mahony concludes that the treatment as a whole was a failure, precisely because of Freud's obliviousness to the transference and his need to prove his own theories.
Lacan, writing in a paper (1953/2002) first delivered more than 30 years before Mahony's monograph, acknowledges the presence of these complaints: “The successes obtained by Freud now astonish people because of the unseemly indoctrination they appear to involve, and the display thereof . . . strikes us as nothing short of scandalous” (p. 76). Yet, in his eyes, these criticisms are irrelevant. Freud obviously recognized the importance of the transference, since he documents the comments that validate it (p. 77); the fact that Freud intervenes so actively in the treatment is not a problem: he “let himself be duped” into intervening, because he “understood the seductive scope of this game” (p. 77) that was played out in the interaction between the members of the dyad.
This complete divergence of views is striking. For Mahony, the main issue, when discussing these opening sessions of the treatment, is, as was the case with Arlow's comments quoted above, Freud's technique. Frequently, Mahony makes observations like this one: “the very absence of detailed transferential interpretations . . . fuels the doubt that Freud persistently focused on clarification and dissolution of the transference neurosis” (1986, p. 89). In this comment, as throughout the monograph, the author consistently criticizes the technique based on an assumption of the theory that the goal of analysis is dissolution of the transference neurosis, and this will happen through a focus on transference interpretations, in the “current situation” (p. 90) of the analysis, with the help of interpretation of resistances (“Freud's approach, intellectual as it was, yet managed to lower the Rat Man's resistances” [p. 114]), while the analyst remains otherwise as unobtrusive as possible, not “intrusive” or “reassuring” as Freud was with the Rat Man. Indeed, the fact that Freud was invested in his own theories of etiology and technique is evidence that his technique is bad. But why dissolution of the transference neurosis is desirable or the goal of the analyst's interventions, or, for that matter, why it is that focusing on the transference will necessarily result in a dissolution of the transference, or why verbalizing analysis of resistances is useful for this process, or why this particular kind of neutrality is necessary, is never brought into question. What exactly does “dissolution of the transference” even mean? That there would be a completely “real” understanding of one's analyst? And what would that be? And why would that be a necessarily helpful thing? As the basis for Mahony's critique of Freud, answers to all these questions are assumed; furthermore, these assumptions serve to valorize a particular conception of technique—the basis for the critique. In this respect, Mahony's monograph calls to mind Kirsner's (2000) criticism of the institution of psychoanalysis: that “the very question of what posits ‘knowledge' is less and less posed nowadays” (p. 250).
Lacan, on the other hand, is skeptical about the valorization of technique in post-Freudian analysis: “It has, in truth, assumed the appearance of a formalism, that is taken to such ceremonial lengths that we might well suspect that it bears the same similarity to obsessive neurosis, as Freud found so convincingly in the practice . . . of religious rites” (1953/2002, pp. 76–77). A few years later, in a talk commemorating the centennial of Freud's birth (1956/2006b), Lacan is more pointed: “As the objectives of analysis lose their importance, ritual forms of technique become more highly valued” (pp. 388–389).
It is striking that the analyst who experimented with short sessions and proposed “oracular speech” (cf. Fink, 2007, p. 87) is praising Freud for a technique that is decidedly more pedantic and explanatory than anything we have come to associate with Lacan's work. Lacan himself acknowledged this: “The point here is not to imitate him. In order to rediscover the effect of Freud's speech, I won't resort to its terms but rather to the principles that govern it” (1953/2002, p. 78). I would suggest that, in its simplest terms, Lacan considers formal technique a secondary issue because analysis is not intended to communicate or even discover knowledge, but to “[m]aintain . . . the dialectic” (p. 86) that will allow the analysand to work through his neurosis according to the theory Lacan develops in this paper, a theory that is based on the way Freud conceptualized clinical effects in the examples above: through attention to what the analysand says, and to the surprises that arise in clinical work. This is one of the main principles governing Freud's work. Freud's investment in his theories, his efforts to get the Rat Man to keep talking despite his mounting anxiety, were the features of his technique in this case that made the analysis possible, not the impediments to a successful outcome. In fact, if a candidate at most analytic institutes were to present a patient with the Rat Man's symptoms as a possible control case today, it would almost certainly be rejected by the supervisor as unanalyzable. And the supervisor would be right to do this: a training that is focused on the learning of a technique, “orthodox” or otherwise, would be unable to have much effect on a severely obsessive analysand, for whom minimizing the impact of other people—a primary goal of obsessional thought—is made ridiculously simple by the presence of such formalism. One more compulsive ritual to add to the list.
For Lacan, as for Freud, the question of what psychoanalysis is trying to accomplish is not taken for granted. For Arlow and Mahony, the answer to this question is assumed, so it need never be asked. That answer entails a belief in objectively demonstrable fact—whether it be in the transference neurosis of the Rat Man or the tape recording of an analytic session—waiting to be uncovered by the application of a proper technique. Lacan not only rejects the ideal of analytic objectivity as invalid, he argues that the concept of such objectively validated work, independent of the dialectic—the back and forth of the analytic process that keeps it in play—is in itself damaging to the subject. For Lacan, the notion that analysis can establish an irrefutable understanding of (or for) the subject can only lead to an objectified perception of oneself, where “subjectivity is admitted into analysis only as long as it is bracketed as an illusion”(1953/2002, p. 89). In other words, the technique that makes subjective experience resolvable into objective reality—“you thought your analyst was like your captain, but that is not what he really is”—only alienates the subject from his own subjectivity more. As it happens, one piece of factual evidence Mahony gives for the Rat Man's analysis being a failure is that, afterward, he married the wrong woman (Mahony, 1986, pp. 216ff.): subjectivity cannot get more objectified than that.
Analysis cannot be a set technique, then, because it is not about arriving at an objective mastery, either by the analyst of his technique, or by the analysand of his subjectivity. Rather, analysis is about uncovering something that is normally hidden from all our efforts at mastery, a truth that cannot be reduced to a record of empirical experience, a know-how that had been unthinkable up to that point. Thus, rather than helping, the mastering of a formal technique is actually an impediment to analysis ever producing analytic effects.
Instead, the analyst must focus on the analysand's speech. The biggest danger to the continuation of the analysis is when the analyst doesn't do something to make the analysand speak. Lacan said this in a particularly emphatic way: “There is only one resistance, the resistance of the analyst” (1988, p. 228): if the analysand doesn't say anything that could lead to a decentering of the subject, the analyst should take action. Implicitly, at least, this is Freud's focus as well. Not only in a throwaway line about “wild” analysis, or the way he intervenes with the Rat Man, but in all his work on the relation between theory and practice, Freud's point was never to uncover objectively discernable facts about one's life; rather, it was to pay close attention to what was said, wherever that might lead. The Freudian subject, we could say, is not the sum of the objective facts of one's life; rather, it is the effect of discourse. From a Freudian perspective, the “wild” intervention of the young divorcée's physician was inappropriate not because of its content but because of how it was presented: rather than an analytic construction, intended to further the discourse about her symptom, the possibility of a link between her sexuality and her anxiety was presented as a therapeutic recommendation: she should find some sexual outlet. This intervention is not analysis precisely because it aims to resolve a symptom, not to “maintain a discourse.” If the intervention proves useful, as Freud suggests it may turn out to be, it is because it shocks the patient into thinking differently about her symptom: it makes the discourse move. It is because this type of recommendation would not raise an eyebrow today that it would no longer have any analytic effect.
I became uneasy about how analysis is done and what it is supposed to accomplish fairly early in my training. I observed that, while certain of my control cases were ideally analyzable, according to the literature on analyzability, not much was happening in them: a willingness to use the couch and talk freely, combined with a capacity to relate to me and to tolerate some frustration, was not obviously producing meaningful effects: unlike Freud's “wild” analyst, nothing I was doing was turning up many unpredictable responses. I found myself committed to the values of analytic theory, but having a hard time linking that theory to practice. If, as I believed was the case, proper technique applied to an appropriately analyzable analysand would lead to meaningful change, then something different should have been happening.
At the same time, I had been seeing another patient before I started analytic training, whom I continued to see for several years after my training was finished. It was unthinkable that this patient would ever be considered analyzable in my training program: she had no frustration tolerance, was on over 20 prescriptions related to myriad vague medical complaints, and was in pursuit of medical disability when I first met her. But over time, working with this patient generated many more analytic effects, in the sense I am using here, than working with most of my control cases. I now believe this happened primarily for one reason: unlike my ideally analyzable patients, who seemed to know exactly how to talk to their analyst, this patient had no clue. Already spending most of her waking hours at the medical center where I worked as a pain management consultant, she was more than willing to start seeing another doctor on a regular basis. For the first few months, she talked about nothing but her myriad physical symptoms and the medications she took for them, all of which produced side effects of which she also complained. I was confronted very early on with a choice: do I chase her symptoms with more medications and referrals for diagnostic workups, realizing that she is completely lacking in insight, frustration tolerance, or demonstrable ego strengths, while offering “supportive” interventions, or try something different? Thus, I was forced from the beginning to actively create, never mind maintain, a dialectic, if anything was to happen even remotely different from what this person had already been doing for years.
Briefly, I decided early on to wean her off her medications as much as possible. Over time, one consequence of this intervention was that she began talking to me about how much she wanted to stay in my office, even noting, at the end of sessions, how suicidal she felt at the prospect of leaving. A solution she found for this problem was to call me often during the week, either late at night or early on Sunday mornings. But this also had a strange consequence: she could never remember, in the next session, what she had talked to me about on the phone, even if she had called me only a few hours before. In addition, she never complained about physical symptoms or side effects of medications on the phone, instead talking about her subjective experience, but then resorted to complaining about her usual symptoms when we met in person. This made her failure of memory especially curious: why was it easier to talk about her personal experiences when we were not in the same room? I eventually insisted that, if she had to talk to me over the phone, then the length of the next session would be cut by the amount of time that we talked outside the session. Over time she talked in our sessions about the same things she had talked about in the middle of the night, and we spent even less time on somatization.
From the perspective of later years, I would argue that there was an unambiguous analytic process in this case, as the patient went from being an “it” that suffered various medical misfortunes to an “I” who could claim a role in her own experience, to paraphrase Freud's strange formula at the end of the thirty-first New Introductory Lecture (1933, p. 80).1 It is at least arguable that this patient had as much of an analysis, if not more of one, than many more imminently analyzable subjects.
That said, at no time while I was actually working with this patient did I think of what I was doing as “real” analysis: using medication management as a spur to talking or cutting the length of a session because of calls in the middle of the night would not pass muster as analytic technique with any certification committee with which I was acquainted. It was only when I became a supervisor myself that I was able to question the legitimacy of the conceptualization of technique I had been taught: I saw much more clearly with supervisees than I had in my own work that along with a focus on how psychoanalysis is supposed to be done—its technique—comes perplexity when the effects of that technique do not lead to the results we had imagined would follow when we started training. Like me, my supervisees lacked a theory of what to make of this. Each dealt with the problem differently—some very creatively—but it was striking to me that we should all have been so stumped by what I am now certain is a very common problem.
For clinical psychoanalysis to have a meaningful place in the world, it is necessary that analytic effects—and not analytic technique—be the central focus of clinical training. If analysis is defined by its technique, there is no sense of analytic effect, in the way I believe Freud, Bernfeld, Lacan, Laplanche, and Leader would apply such a term: the discovery of something new. Further, the analyst-in-training is trapped without a critical perspective on the monolithic importance of technique, left to either imitate or rebel against the models of technique he has been taught. Unfortunately, as in the examples of Arlow's commencement address and Mahony's critique of Freud, there is very little focus in most analytic training on what exactly is to be expected from analysis, other than that the analysand should get better, as a consequence of . . . proper analytic technique. The argument becomes circular, and the reason for conducting analysis at all becomes increasingly unclear.
Perhaps some of this confusion could be avoided if analytic praxis were thought of less as a kind of therapeutics and more as a poetics—literally, a “making” rather than a “healing.” What I have argued here is that, because of its focus on the production of effects, which may look nothing like “healing” (consider the vignette I describe above: how can a patient who goes from complaining about side effects of medication to feeling suicidal be considered to have progressed), psychoanalysis is in a very strange position as a therapeutic entity, at least as therapeutics are defined today. On the other hand, in any kind of making, there is of necessity little or no attention given to restoring a previous status quo, as is always the case with therapeutics outside of psychoanalysis; instead, there is a focus on creating something new. This, I believe, is much more relevant to psychoanalytic practice than an appeal to a reproducible therapeutics. In any case, there is nothing revolutionary about suggesting this possibility. Consider that Freud appeals to Friedrich von Schiller's advice to a younger poet with writer's block to argue for freedom of associations as early as “The Interpretation of Dreams” (1900, pp. 102–103).
Several times while I was working on this article I found myself thinking of a particular poetic manifesto, Charles Olson's “Projective Verse” (1950/1997), which is contemporaneous with Lacan's psychoanalytic manifesto (Lacan, 1953/2002) quoted above, and which shares at least some elements of the zeitgeist2 with it. In looking back over the essay I was struck by shared emphases between how Olson describes the work of writing poems and the work of analysis as described by Freud, Bernfeld, Lacan, and Leader. First, Olson insists on the importance of the effect of the poem: “A poem is energy transferred from where the poet got it . . . all the way over to, the reader” (p. 240), just as Freud, Bernfeld, Lacan, and Leader have insisted on an effect of analysis as the primary focus. Of note, this is a decidedly nonscientific way of thinking about a clinical activity: rather than focusing on whether or not a particular technique is objectively reproducible, like the clinician-scientist, the analyst, like the poet, is more concerned with whether or not an intervention has an impact on the analysand.
Second, Olson notes that each poem will be different from every other by virtue of the specificity of perception that informs it; thus, it is at least limiting for the poem to be formally constrained by technical rules for reasons that resonate with Freud's: every perception will be unique, and lead to another, further unique perception. Is this not consistent with Freud's way of talking about dreams, or interviewing hysterics?
Olson's term for “open” verse as opposed to “closed” is “composition by field”—implying that every poem will be written out of a unique field of perceptions, both internally, what is going on in the writing of the poem, and externally, in the world outside the poem. Even the question of subjectivity and objectivity as taken up here seems relevant to our concerns: Olson makes a distinction between self-awareness as the focus of the poem—the “Egotistical Sublime,” as he calls it—and a focus on the perception of the subject as such. This strikes me as not dissimilar from the distinction, in psychoanalysis, between a focus on the self-conscious subject and a focus on the unconscious subject, a problem addressed by Laplanche's (1992/1999) theory of the “Copernican” versus “Ptolemaic” position of the subject of psychoanalysis. In both poem making and analysis, then, it is not enough for the involved parties to make a good-faith effort to describe what they know; rather, the goal is always to find something new.
From Freud's comment in 1910, then, to Lacan's 1953/2002 manifesto, to Bernfeld's memories of Freud (1962), to Laplanche's theory of the unconscious subject (1992/1999) and Leader's comments in a newspaper in 2008, there is a consistent thread: psychoanalysis is not defined by its technique, but by its effects. To be clear, while we may not know what particular effects will be produced in any given case, we do know that there will be effects, as long as we use our knowledge to engage with the unknown and unknowable. We can even say something about what these effects will be: there will always be some element of surprise, of the new, in them; furthermore, they will be the consequence of analytic discourse, not of an arrival at a particular understanding. And they won't result from the application of a predetermined technique, regardless of that technique's expressed goals. To insist on a particular technique—any technique—as a requirement for a successful psychoanalysis is a diminishment for the possibility of producing analytic effects.
Maintaining the psychoanalytic dialectic in the 21st century—in the era of the DSM-IV and Ritalin, zombie movies and sex manuals—is decidedly different from maintaining the dialectic in the early 20th century. What does not change in psychoanalysis is not a technical procedure that worked at some point in the past, but the need to always find new techniques—a new technique for every analysis, perhaps3 —that keep the dialectic alive.
1 Freud's “ Wo Es war, soll Ich werden ” is translated in the Standard Edition as “Where the id was, there the ego shall be.” Both Lacan (1955/2006a, p. 347) and Loewald (1970, footnote p. 48) criticize this translation, for basically the same reasons: not only is it grammatically incorrect, it implies that building ego strength is the point of analysis, while both Lacan and Loewald argue that change is a direct result of putting “it”—a desubjectivized experience, as when a symptom is experienced as having no connection to the psyche—into words.
2 Cf. Robert Creeley's (1993) introduction to Olson's Selected Poems : “A characteristic of our time has been its insistent preoccupation with system”—a preoccupation Olson shares with Lacan.
3 “[T]he most successful cases are those in which one proceeds, as it were, without any purpose in view, allows oneself to be taken by surprise by any new turn in them, and always meets them with an open mind, free from any presuppositions” (Freud, 1912, p. 114).
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