Psychoanalytic interpretation of experiences. Psychoanalytic interpretation of human existence. Symptom Meaning and Symptomatic Interpretation
“Counseling Psychology and Psychotherapy, 2012, No. 4 PSYCHOANALYTICAL INTERPRETATION AS A RESEARCH STRATEGY N.P. BUSYGINA The article discusses methodological...»
Counseling psychology and psychotherapy, 2012, no. 4
PSYCHOANALYTICAL
INTERPRETATION AS
RESEARCH STRATEGY
N.P. BUSYGINA
The article discusses the methodological features of psychoanalytic
interpretation as a research strategy. The author shows that in
psychoanalysis, a special cognitive attitude is realized, characteristic
the features of which are the emphasis on the disclosure of meanings and the premise of self-sufficiency of experience, which brings psychoanalysis closer to phenomenological and hermeneutical approaches. Particular attention is paid to psychoanalytic psychobiography and the symbolic nature of the language of psychoanalysis. The significance of psychoanalytic interpretation for the methodology of psychology is discussed.
Key words: psychoanalysis, interpretation, classical and humanitarian methodologies, experience, meaning, psychoanalytic approach in qualitative research.
Of course, psychoanalysis was created primarily as a clinical practice aimed at therapeutic work with the patient. However, it is well known that Freud repeatedly emphasized the presence in psychoanalysis of not only a therapeutic, but also an exploratory function and spoke of the inseparable connection between treatment and research. The prospect of scientific discovery, of comprehending the deep aspects of mental life, which is inherent in the analytic work itself, seemed to Freud one of the most important and valuable features of the psychoanalysis he created.
Subsequently, the question of the scientific status of psychoanalysis became the subject of many discussions. Powerful philosophical arguments showing the inconsistency (or at least the logical problem) of the concepts and conceptual schemes introduced by Freud were put forward, in particular, by J.P. Sartre and L. Wittgenstein [Rutkevich, 1997]. In the philosophical methodology of science, the representation of Busygin N.P. Psychoanalytic interpretation as a research strategy refers to the non-falsifiability of psychoanalytic theories, i.e., the impossibility of their independent empirical verification, which is a critical indicator for the methodologists of science of the impossibility of recognizing their scientific status [Popper, 2004].
At the same time, there are many attempts to comprehend the status of psychoanalysis in its connection not with the history and methodology of natural scientific knowledge, but in connection with the history of the humanities (the field of Humanities) and in the context of the philosophical tradition of substantiating the specifics of the knowledge obtained in them. In particular, the outstanding German philosopher J. Habermas accused Freud of "scientist self-misunderstanding mania." From the point of view of Habermas, the founder of psychoanalysis believed that he was building knowledge on the model of the natural sciences, and in fact, the psychoanalysis he created is one of the versions of the "sciences of the Spirit", driven not by the technological interest of predicting and controlling objective processes, but by the humanities. interest in understanding meanings and emancipation. A deep understanding of psychoanalysis in the context of hermeneutics was proposed by P. Ricoeur [Ricœur, 2002].
In the perspective of substantiating the specifics of the humanities, psychoanalysis is freed from many sentences given to it by adherents of strict scientificity. Psychoanalysis is declared not so much a science as a means of interpretation. Of course, the requirement of validity applies to interpretation - including validity by data, "clinical facts", text, etc.
P., - however, we are not talking about the strict application of Popper's principle of falsifiability in relation to it. The value of interpretation lies in unraveling the meaning, including one that is hidden from the author himself. As Yu. Habermas notes, psychopathological states are nothing but a kind of alienation, in which the subject is cut off from his subjectivity, experiences himself as an object, separated in his symptoms from his own meanings (motives, desires) - and this what, according to Habermas, psychoanalysis is trying to fix. Psychoanalytic understanding, in this context, is not a process of looking for mechanical causes, but a way of restoring the subject's disturbed identity with its own subjectivity. "The experience of reflection - the most important element of the culture of enlightenment - is precisely the action with the help of which the subject frees himself from the state in which he is the object of the forces acting in himself" . And through interpretation, the analysand is able to connect with lost or hidden meanings and reclaim them. With some degree of conventionality, it can be said that this is a causal process, that psychoanalysis reveals the causes of pathological symptoms, but these causes lie in the field of recreating the semantic fabric, and not in the field of identifying some special “psychic facts”. In general, it should be recognized that the hermeneutic version of psychoanalysis had a significant impact on the modern understanding of its status, although it was subjected, in turn, to rather harsh criticism - both from philosophers (see, for example, the designation of the main lines of such criticism in [ Rutkevich, 2000]), and from the psychoanalysts themselves 1.
In psychology, the attitude towards psychoanalysis is also quite complex.
On the one hand, psychoanalysis is recognized as one of the most important areas, psychoanalytic ideas are taught to students of psychology within a number of educational disciplines (general psychology, history of psychology, personality psychology, etc.), programs for training specialists in the field of counseling psychology, as usually include separate courses in psychoanalysis.
It can be said that many psychologists have recognized a number of propositions of modern psychodynamic theory, such as the very existence of unconscious motivational processes, the ambivalent nature of motivational dynamics, the role of childhood experiences in psychoanalysis. Concerning criticism of the hermeneutic reflection of psychoanalysis, I would like to make a brief remark. Psychoanalysts [Kadyrov, 2010; Steiner, 1995] overly exaggerate the idea of "infinite interpretation", allegedly inherent in the representatives of philosophical hermeneutics. Even authors who deal only with the problems of text interpretation and practically do not affect the reality of the psychoanalytic session think much more realistically and just limit interpretation to the function of its “programmability by the text.” And in the most famous version of the hermeneutic interpretation of psychoanalysis, proposed by J. Habermas, it is directly stated that the validity of psychoanalytic understanding always depends on the situation of the clinical setting: the validity of the analyst's interpretative moves can only be discussed if "they are accepted as knowledge by the analyzer himself. Since the empirical validity of interpretations is based not on the actions of controlled observation and subsequent communication in the research community, but on the promotion of the process of self-reflection of the analysand and his communication with the analyst. Psychoanalytic knowledge is validated by its ability to demonstrate in practice the efficacy of interventions based on it; being recognized by the patient himself, it becomes for him a powerful source of expanding the horizons of self-understanding.
the formation of many personal dispositions, mental representations of “I” and “others” and the relationship between them (“object relations”), analysis of the narcissistic component of personality, etc. [Dorfman, 2003; Sokolova and Chechelnitskaya, 2001; Westen, 1999]. On the other hand, however, psychoanalysis remains for psychology (at least for the mainstream of university psychology) a kind of marginal field, and psychological departments, even introducing it to students, treat it rather as a historical phenomenon (see. , for example, curious material on this topic:). More or less serious analysis in psychology is given to the ideas of the psychoanalytic school of "object relations". Other versions of psychoanalysis are sometimes perceived as a kind of arte facts or myths.
The described attitude towards psychoanalysis in psychology is largely related to the peculiarities of the latter's self-determination in a number of natural sciences and the humanities. It cannot be said that psychology to this day is completely guided by the methodological models of the natural sciences - after all, it has its own history and its own path of modern development, different, say, from the path of development of physics or biology.
But it is safe to say that, until recently, psychology paid practically no attention to humanitarian methodologies. Therefore, in psychoanalysis, what turned out to be valuable for many humanitarian disciplines (in particular, the path of interpretive cognition of a special kind proposed in psychoanalysis) did not receive any serious understanding and development in psychology.
A few years ago, on the pages of the journal Counseling Psychology and Psychotherapy, I.M. Kadyrov [Kadyrov, 2010] raised the topical issue of the epistemological status of the situation of a psychoanalytic session and tried to show that the psychoanalyst has his own foundation of “psychoanalytic clinical facts” – “subjective”, “mobile” and “ephemeral” and, nevertheless, , very real, tangible and significant both for the internal "ecosystem" of each individual session, and for the patient's life outside the psychoanalytic room [Ibid. S. 11]. According to the author, these facts are the patient's psychological events that he enacts on the "stage" of his relationship with the analyst. For the field of methodology of psychology, this may mean that psychoanalysis offers a very specific type of cognition, the factual side of which unfolds in a special world of interaction between the patient and the analyst, and the "clinical facts" obtained in this way are quite accessible to intersubjective verification - in a session with a patient and in a collegiate context. Thanks to the invention of "unusual conditions of the analytic hour", psychoanalysis opens up the possibility of a deep study of the internal organization of the psyche [Ibid. P. 29], however, this methodological heuristic of psychoanalysis, perhaps, has not yet been adequately evaluated by scientific psychology.
I think that not only the discovery of the unique situation of the analytical session as a possible space for deep knowledge of the personality has remained “overboard” in the methodology of psychology. In psychoanalysis, a special cognitive attitude is realized, which can be attributed to one of the forms of the “modern way of thinking” (in the terminology of M.K. Mamardashvili). The use of projective methods in psychology, based, among other things, on psychoanalytic ideas, is connected only partly with this attitude [Sokolova, 1980; Sokolova, Chechelnitskaya, 1997], as well as some original variants of the author's clinical methods (as an example, we can cite the method of dialogic case analysis [Sokolova, Burlakova, 1997]). On the whole, it can be said that the methodological meaning of the mental attitude implied by psychoanalysis has not been clarified in psychology and the attitude itself has been little actualized.
The purpose of this article is to reveal the features of the cognitive attitude implemented in the method of psychoanalytic interpretation, and to show what significance it has for psychological studies of personality.
In the proposed analysis, I focus on the logic of substantiating the psychoanalytic approach as a qualitative research strategy. Basically, I turn to the classical version of Freud's psychoanalysis, I also use some of the works of J. Lacan. The question of the difference between Lacan's version of psychoanalysis and Freud's line is not raised here, just as no special analysis of Lacan's ideas is given. However, my reading of Freud's work is conditioned by the optics proposed by J. Lacan and subsequent [I would replace with "following him" if this is actually true?] French authors of the Lacanian type (J. A. Miller [Miller, 2004; Miller, 2011], etc.).
I believe that French authors (by the way, not only Lacanists proper, but also those who are usually referred to as “post-structuralist philosophy” - M. Foucault, J. Derrida, Y. Kristeva [Foucault, 2004; Derry yes, 2000; Kristeva 2010]. In other words, they did something not even with Freud's texts themselves, but with those who read these texts.A Freud who has gone through the history of his French reading is the modern Freud, in the sense of "modern stylistics of thinking" [Mamardashvili, 2010 ]2.
The Meaning of a Symptom and Symptomatic Interpretation One of the well-known and often cited propositions of psychoanalysis is the assertion of the meaning of seemingly meaningless phenomena - erroneous actions, slips of the tongue, slips of the tongue, dreams, and, finally, symptoms. This means that they are related to the experience of a person, are embedded in the content fabric of his mental organization and can be revealed only in this context.
For example, Freud's patient is obsessed with a meaningless idea that can be qualified as a delusion of jealousy [Freud, 2000a, p. 12-19]. The psychiatrist will be puzzled by how exactly to determine the essence of the symptom, whether the observed can be attributed to a delusional idea, an obsessive thought, a hallucination or an illusion3. Freud, on the other hand, offers to penetrate into the very content of the symptom and discovers that the patient's delusional idea about her husband's love for a young girl is the result of a displacement, apparently, of her own unacceptable, unconscious and therefore "dead weight" falling in love with a young man lying in the unconscious - husband M.K. Mamardashvili proposes to call “modern” (as opposed to “classical”) something that requires a fundamental restructuring of the structures of thinking for its understanding [Mamardashvili, 2010, p. 27]. For example, a work of classical art can be understood by means of those mental tools that we already have in life, while a work of modern art suggests that in order to understand it, we must do something with ourselves, restructure our habitual understanding skills [Ibid.]. Today it is practically impossible to read Freud based on some familiar ideas - with such reading, bewilderment arises: where did he ever see such children who want their mother, compete with their father, etc. In order to adequately perceive Freud, one needs to find a suitable position - "to do something with oneself", in the words of Mamardashvili.
By the way, a psychologist performs the same mental action when he qualifies a person as an extrovert or introvert, “personally mature”
or “immature”, having a high or low “personal potential”, etc.: both in the case of a psychiatric diagnosis and in the case of a psychological assessment, we are talking about determining the mental / psychological status within the already known, conditionally “objective” coordinate system.
Theory and methodology
his daughter. “The fantasy of her husband's infidelity was thus a cooling compress on her burning wound” [Ibid. P. 17] and, in a certain sense, freed her from internal self-reproaches. Behind the symptom is hidden a personal history that forms the symptom in a special way as an intentional, semantic formation4. I emphasize once again that Freud does not qualify the type of symptom and does not give its causal - in a mechanical sense - explanation (i.e.,
does not reduce to some traditionally understood law in the form: a delusional idea arises under such and such conditions), but deals with the interpretation of the meaning of the symptom, he shows, in the given example, that the patient’s delusional idea is really meaningful, motivated and connected with the whole the logic of her emotional experience. The symptom feeds on the power of some unconscious process, and in such a way that in a sense it is itself something desirable, a kind of consolation.
For Freud, the symptom stands out from the rest of the formations of the unconscious by its constancy. Although Freud himself, speaking of symptoms, has in mind, first of all, their clinical variants, in fact, his logic of discussing symptoms is such that many features of speech, behavior, life manifestations can receive the status of a “symptom” - something, which is not directly related to the actual clinical phenomena: recurring themes in creativity, preferences for preference Due to the lack of material, Freud in the analysis of the case cited is limited to stating the unconscious love experienced by the patient, which feeds itself through the displacement of delusions of jealousy. Of course, one can imagine a variant of further interpretive movement, as if Freud's patient was now in front of us. For example, why does this seemingly happily married woman suddenly begin to experience falling in love with her daughter's husband? And why is relief achieved in this way - by projecting one's condition onto her husband? How does the patient experience her age, her sexuality, what happens in her relationship with her husband, and what is her relationship with her daughter? It is important that in any case, behind the surface of the symptom, there is supposed to be a layer of some other meanings that can line up in the semblance of narrative plots. This semiosis, however, does not exist by itself, but is always closely connected with processes related to the "libidinal economy". J. A. Miller [Miller, 2004; Miller, 2011] rightly notes that in Freud’s reflections on the symptom, two lines are everywhere present - the line of meaning, which is the unfolding of chains of signifiers, and the line of pleasure (jouissance): despite the phenomenology of suffering, a symptom is always nothing but a kind of libidinal satisfaction.
Busygina N.P. Psychoanalytic interpretation as a research strategy
la and colors in clothes, habitual positions in communication, etc.
I mean that Freud offers a special - "symptomatic" - way of understanding what we can directly observe.
P. Ricoeur [Ricœur, 2002] speaks of the difference between the traditional “hermeneutics of understanding” and the psychoanalytic “hermeneutics of suspicion”, such a definition of psychoanalysis is close to J. Habermas’ reflections on psychoanalysis as an “emancipatory science”, as well as the view of psychoanalysis as “deep hermeneutics” [Busygina, 2009a; Lorenzer, 1996]. If the symptoms - both in their clinical and wider sense - have meaning, then they are accessible and need to be interpreted, the idea of the semantic nature of symptoms, in fact, brings psychoanalysis closer to the position of hermeneutics, however, at the same time, this the semantic nature of symptoms is of a special kind, which makes it inaccessible to the traditional hermeneutic reading, and gives the psychoanalysis that deals with it a special status. In a symptom, the meaning does not speak for itself, the surface on which the meaning is expressed and observed does not coincide with the surface on which the very action of meaning formation takes place. In order to understand what we are dealing with, it is not enough to move within the hermeneutic circle defined by the structures of linguistic pre-understanding, there is always some kind of trap hidden behind this surface, so understanding the meaning always needs not just linking the whole and the part stey (although in this too), but also in deciphering hidden meanings that are not known not only to the analyst, but also to the analysand himself. We “suspect” the presence of a “deep” other (hence “deep hermeneutics” and “hermeneutics of suspicion”), a discourse of the unconscious that is both hidden and reveals itself in linguistic and behavioral expressions.
The position of "symptomatic reading" is what psychoanalysis opens up to the methodologies of psychology, especially those areas of psychology that are concerned with the development of qualitative methods. A possible variant of its application in relation to a fragment of an interview in a number of other types of qualitative analysis (the content of analytical and phenomenological methods) was proposed in my other work [Busygina, 2009b]. Here I will give an example of a curious symptomatic interpretation of the material of life, which does not belong to the actual clinical symptomatology. The interpretation is given by J. Lacan, borrowing the material itself from one of his colleagues [Lacan, 2002, p. 294-296]. In this example, I am highlighting the specifics of how symptomatic interpretation works.
Theory and Methodology The heroine of Lacan's story is a skilled, highly professional woman who is also a wonderful wife and housewife. Everything is beautiful with her and in terms of sexual pleasure - wonderful to such an extent that this simply does not happen. “Such an accident is so rare that it cannot go unnoticed,” Lacan notes, inviting us to adopt a methodological “suspicion position.” In professional situations, a woman often demonstrates “specific acts of seduction and self-sacrifice”: for example, in some situations she suddenly begins to belittle her strengths and knowledge, while deliberately emphasizing her female priorities, interests and weaknesses. How can a psychologist relate to the material described by Lacan? For example, one can read features of behavior as an expression of specific personality traits, the totality of which creates something like a "personality profile", or as a manifestation of features of personality structure. In a phenomenological vein, the effort of understanding will be directed to the peculiarities of the woman's life experience, the "life world" she lives - in the context of her own self-understanding. Lacan, on the other hand, proposes to read the very behavior of a woman as a "symptom" - an external expression of processes, the meaning of which is hidden from herself. By her behavior, she seems to anticipate imaginary male aggression, which, in turn, can be motivated by the fact that in her ideas this woman, being a qualified professional and quite a significant subject in her business, seems to secretly take away from men the most the main thing is the source and symbol of their power. Her femininity takes the form of a kind of masquerade: displaying her “phallic power” as a professional, she immediately “femininely” expresses doubts about her competence, expresses anxiety about what she is doing, pretends not to know very well, etc. ., she seems to immediately say: look, I'm just a woman, and nothing more. With her game, she, as it were, appeases those from whom she can take away superiority. Moreover, her game is not conscious, but is part of her "life style" - she lives in this way.
It should be noted that it is precisely with symptomatic interpretation that the problem of hyperinterpretation is often associated - deliberate attempts by interpreters to read out secret meanings everywhere, even in the simplest things, the meaning of which is obvious. S. Frosch and P. Emerson rightly warn of the danger of hyperinterpretation that psychoanalytic interpretations bring with them. However, in the situation of a psychoanalytic session, the orientation analyst Busygina N.P. Psychoanalytic interpretation as an exploratory strategy takes into account the totality of what happens in his relationship with the patient, he has access to a rich context of reactions, emotional responses, bodily manifestations of the patient and his own countertransference experiences, and his interpretation is related to this whole context. It is more difficult to interpret in a research situation, since the researcher is usually deprived of all the richness of feedback that the practicing analyst has. And yet, despite the fact that the problem of the validity of an exploratory interpretation oriented towards a symptomatic reading is, in fact, still far from a final solution, validation strategies are available to the researcher based on working with data as a whole complex, when the interpretation is repeatedly rechecked by correlating it with various fragments of data, and in case of its inconsistency with some fragment, corrections are made to it. On the whole, symptomatic interpretation, provided that reflexively critical checks are built into it, is one of the powerful sources of heuristics.
The Phenomenological Modus of Psychoanalysis Quite often in psychology, psychoanalytic interpretation as an “objectifying”, “reducing” interpretation is opposed to phenomenology as a way of comprehending subjectivity in its entirety without resorting to theoretical models and schemes. I think that this point of view is not entirely correct. In psychoanalysis and phenomenology there is a certain common dominant that distinguishes them from classical psychological methodologies. It can be assumed that psychoanalysis and phenomenology have a similar premise, they start from one point, but then their paths diverge. In order to understand what their characteristic "thinking trick" consists of, let us outline the thought movement familiar to scientific psychology by referring to several examples of research taken from different areas of psychology.
An important form of theoretical work in psychology is the creation of explanatory models. As a rule, the model does not give a description of the real experience itself, but introduces what should be experienced, according to the logic of the model. It is possible to evaluate the model by the predictive function it performs. An example of this kind of theoretical work is the explanation of the psychological crisis, which is given by the model of age periodization of development by D.B. Elkonin. According to this model, the crisis is a consequence of the contradictions that have accumulated in a certain life period, the main of which is the mismatch between the motivational need (“personal”) and the operationally technical (“intellectual”) spheres. The model not only outlines the possible causes of crises, but also shows the inevitability of crises (their normative nature). Let us pay attention to the fact that the crisis in the model is deductively deduced as its necessary link, and the model does not involve the study of its real logic, as if from within itself. It seems that having received an explanation of the crisis, we, however, have not received an understanding of what we have already explained. Some important piece of work has been omitted.
One of the widespread areas of empirical research in psychology (in which, by the way, some psychoanalytic ideas are used, in particular the ideas of the “object relations theory”) is the search for external determinants of mental development. For example, there are links between the insufficiently developed autonomy of the individual and the dysfunctional characteristics of the parental family (the simplest case is some kind of defect in the real father: his real absence, alcoholism, lack of proper paternal function, etc.). Although these studies are not about creating a holistic theoretical model, but only about empirical searches for possible determinants, the picture again turns out to be purely external: a factor related to the real microsocial space affects personal characteristics. At the same time, the inner subjective world is again missed. In addition, the dysfunctional factor of the real father explains little, because its consequences can be very different. In order to understand these consequences, it is necessary to go beyond the external description and try to grasp the meaning of how the image of the father is represented on the internal plane, and not only in the sphere of the consciousness of the researcher, but also in his personal history, how he is built into the structure itself. experiences and sets a certain direction for the "life project" of the individual. Focusing on external M.K. Mamardashvili [Mamardashvili, 2010] very accurately outlines the meaning of explanation, paying attention to the English term - explain away, which literally means "to explain away", "to get rid of by explaining" [Ibid. S. 318]. This is not about the uselessness of explanatory models, but about the fact that serious work must still be done before explanation, otherwise the explanation will miss the very reality that it is intended to explain.
Busygina N.P. Psychoanalytic interpretation as a research strategy
factors, it is impossible to approach the core of this issue, for this it is necessary to reorient the view in a special way.
Another example of widespread empirical work is the study of "psychological causality", i.e., the search for psychological determinants that cause certain states or behavioral patterns (say, a relationship has been found between depressive states and such personality factors as perfectionism and hostility to people ). In studies, the quantitative severity of previously described constructs (depressiveness, perfectionism) is recorded and then a search is made for relationships between them - correlational or causal, depending on the type of research design6. And again we run into some kind of impossibility - the impossibility of a holistic view of the subjective world that interests us. “Depressiveness” or “perfectionism” have different meanings, depending on the component of which integral subjective space they are. And in order to understand them, it is necessary to reconstruct this semantic space, how to describe it from the inside. And for this, again, a different view and a different language are needed.
So, in all the examples I have described, the object of psychology - the mental world - is, as it were, observed from the outside, its logic is modeled deductively, objective connections between some of its characteristics are empirically tracked, the factors that determine its features are studied, etc. And everywhere we we run into an obstacle that ultimately leads to the incompleteness of our vision: drawing fragments of an objective picture of the spiritual world, we seem to be missing something, as if we are walking around a fenced, enchanted space, having no means to step inside. A living experience, like a living experiencer, remains outside our sight.
I think that phenomenology and psychoanalysis are close in spirit precisely in that they allow in a different way, not through objective characteristics. Methodologically, it does not matter whether simple mathematical indicators are used, such as calculating correlations, analysis of variance, etc. complex mathematical methods are involved, such as structural modeling, which makes it possible to test hypotheses about the presence of certain latent variables: in any case, we are talking about the selection of point indicators and the search for relationships between them - in more simplified or pretending to form complex, complex models options. The direction of the mental movement is the same, only the specific methodological methods differ.
The theory and methodology of tiki approach the spiritual world, allow you to penetrate into this thickness of subjectivity. The first step taken by E. Husserl in his phenomenological project [Husserl, 2005] is to stop the "automatism of understanding" - to "bracket" the known world.
In my examples of psychological research, an attitude similar to that which is inherent in us in everyday life works. Usually we perceive something through the prism of habitual ideas about what it is, and in psychological research, perception and understanding are similarly mediated by ideas - having a connection with everyday life, but conceptually worked out. Almost immediately, there is an automatic connection of the conditionally “higher layers of consciousness” - the totality of knowledge with which the work is going on (conceptual definitions, clarifications, etc.). Husserl, on the other hand, proposes to slow down this action of the "higher strata" and try to capture the spiritual life in its original, to a known given. Phenomenology presupposes a long gazing and listening into experience, followed by a descriptive reconstruction of this experience as it manifests itself.
And, in my opinion, Freud does the same from the very beginning - he seems to “suspend” the judgment about experience, does not hurry to designate this experience, but gradually “unpacks” the semantic reality of a symptom or mental formation. Crisis experiences, depression, features of the microsocial climate, external objective connections in this logic for some time cease to be known, quite definite entities, but turn out to be presented in a special way - in the form of an indecomposable, syncretic, integral internal phenomenon capable of “self-showing”. . We can say that the phenomenon in psychoanalysis manifests itself within a certain chain of meaning. In one of Freud's studies [Freud, 1998], the phenomenon of a mysterious smile, which is endowed with the artistic images of Leonardo da Vinci, gets its meaning in the context of the interpretation of one of Leonardo's fantasies, in which a kite flies up to him, a little boy, and touches him several times with his tail. mouth, as well as in the context of some biographical data about the artist. The smile in the paintings refers to the lost kisses of the mother and, moreover, in a strange way reveals to us the type of homosexual sensuality of the author (not behavior, but precisely the type of sensuality), in which the individual is identified with the gaze of the mother and searches for himself in the objects of love (“ narcissistic choice of object).
What is close to phenomenology in this thought movement of Freud?
Focus on the semantic component, on the very reality of inner life, which manifests itself under certain conditions - under the condition of Busygin N.P. Psychoanalytic interpretation as an exploratory strategy of stopping a known judgment about experience and then attempting to explicate what appears. Features of life, creative style, the figure of the mother - everything appears in the form of an internal semantic space that shows itself in a special way. However, the same example clearly shows the differences between the Freudian interpretation and the phenomenological study. In phenomenology, it is supposed to search for what is given with obviousness, at the level of apodictic truths. Freud, on the other hand, undertakes the interpretation of the meaning, using symbolic interpretation, resorting to cultural knowledge, beliefs, etc. In the vulture fantasy, he does not refer to the legend, common in Leonardo's time, according to which all kites are female and conceive from the wind. In other words, Freud does not stay in a phenomenological setting, the core of which is the epoch, but exposes himself to a certain screen onto which he projects the baggage of possible knowledge - but hidden knowledge, actualized with some time delay. The same operation can be traced in the interpretation of dreams, especially women's dreams, which, in fact, reflect how the feminine theme is presented in culture (and in the male soul)8.
So, starting the movement of understanding from the same point as the phenomenologist, as if "suspending" the known designation of experience, Freud then embarks on a completely different path - not the path of describing the givenness of meaning to consciousness, but the path of deciphering the expressions of meaning in consciousness [Ricœur, 2002]. I mentioned the symbolic interpretation used by Freud, but it is certainly not the core of psychoanalytic interpretations. As already mentioned in the previous paragraph, Frey has intelligibility, i.e., the intelligibility of the meaning supplied. As it turned out, Freud made a mistake with the name of the bird, and his entire interpretation is based, in fact, on a translation error, but in this context, the fact of this mistake us not very interested.
For example, in one of her patient's dreams [Freud, 2000b, p. 335, 338-339, 343-344, 361-362] the theme of female sexuality, symbolized by white, red and then withered flowers, is easily associated in Freud with those of trauma, aggression, fear. This is the screen onto which something is projected, represented in Freud himself. From the cultural context, Freud chooses only what is close to the male gaze, and the female story receives a certain semantic content, in which the picking and wilting of flowers is unequivocally interpreted as a loss (of innocence, youth, etc.), in reality, in In such images, if we take into account the general tone of the dream, another semantic dominant can be concluded - the experience of being included in some natural cycle, frightening and desirable at the same time.
Theory and methodology
dreams, symptoms, phantasies, features of repetitive artistic images, cannot be reached at the same level of discourse as these actions of meaning themselves. Consciousness is cut off from its own meaning by an obstacle - a barrier of the repressed. The phenomenologist, in the process of his own research, also encounters something that goes beyond the limits of consciousness, which is an irreflexive thickness of experience. But the phenomenologist does not go into this thickness. In order to go there, one must leave phenomenology and give a model of the unconscious that will allow one to reach the meaning of the actions it performs.
Freud offers two well-known topics of the psychic apparatus, describes the "economics of desire", etc. Freud's entire metapsychology subsequently provoked severe criticism, Freud's models were changed, replaced, etc. For me, it is now important to note where thinking begins. the course of hypostasizing models of the unconscious, the difference of which, in fact, lies in the main doctrinal difference between the available versions of psychoanalysis: the psychoanalytic model follows phenomenology in its turn to subjectivity and rotates in a circle centered on the internal movements of experience.
Undoubtedly, the hypostasis of models is the point of fundamental divergence between psychoanalysis and phenomenology, the model of the unconscious is something that cannot be deduced from phenomenological experience, but at the same time it is what makes it possible to interpret the thickness of the ir reflexive, before which the phenomenologist stops. Phenomenology and psychoanalysis begin at the same point of suspension of external judgments of experience, but psychoanalysis proper begins where phenomenology ends.
Personality Features as a "Package" of a Psychobiographical History
[Ricœur, 2002], the method proposed by psychoanalysis is “genetic interpretation”, i.e., the reconstruction of the past according to the traces left by mental processes [Rutkevich, 1997]. In the above example of the study of the life of Leonardo da Vinci, Freud fixes a number of mysterious traces: a specific research curiosity, characteristic not only for scientific, but also for Leonardo's artistic experiments, the paucity of sexual life, the features of artistic handwriting (the already mentioned smile of Mona Lisa and other images of the artist ), finally, another curious trace - either a dream, or a memory, or a late fantasy about a kite. "Traces of symptoms" provoke N.P. Busygin to recreate. Psychoanalytic interpretation as an exploratory strategy of the semantic whole, which Freud produces by reconstructing the past: Freud describes the early years of Leonardo's life, spent by him with his own mother, from whom he later, still in childhood, due to special circumstances, was separated. The life of early experiences leaves its mark in such a way that the subsequent psychic life is fixed on the moment of infantile sexuality associated with the figure of the mother. And the enigmatic smile on Leonardo’s canvases is an “archaeological trace” in his soul of his mother’s tender smile, and perhaps his own smile, associated with the highest and at the same time forbidden bliss - in any case, the lost figure of the mother in Freud’s reconstruction in a special way gathers around itself a semantic space, in the light of which individual manifestations of the described life and fate become understandable.
The past that Freud is talking about is not the objective real past, that is, not the past of objective facts accessible to external verification, but the past, internally processed, left its mark on subjectivity, melted into this subjectivity.
There is an interpretation of what, in a certain sense, has already been interpreted - by means available to a childish, infantile organization. Behind the figure of the mother, strictly speaking, not reality is revealed, but a fantasy, that is, something that is already a kind of interpretation. The same can be said about the "primary scene": the observation of the primary scene is a fantasy, reality "melted by subjectivity". Leonardo's "homosexual sensuality" refers not to the objective reality of the relationship with the mother as a signifier to the signified, but to some archeological figure of bliss, the "talking body"9. Behind the trail left by the mental process, it is impossible to detect something conventionally primary, analogous to the thing, since the primary mental processes themselves, to which, in particular, Freud appeals, in their status are not “raw” materiality, but intentional processes.
So, in psychoanalysis, we are talking about the reconstruction of a special past.
And the reconstruction itself occurs through the use of special environments. An even more striking example is the reference not to the fact of weaning, but to the hostile mother's breast in the works of M. Klein. Or the following ironic remark by J. Lacan: a real father washing dishes in his wife's apron is not enough to get schizophrenia, in other words, this father must also be represented in a special way in the mental plane. The facts of the past - weaning, the peculiarities of paternal behavior - are reconstructed in terms of their internal representation, as facts of internal infantile life.
Theory and methodology of stvostvo - techniques of "stage understanding" [Lorenzer, 1996]. In the relationship between the patient and the analyst, one can observe “life dramatizations”, which in therapeutic practice are called transference and countertransference: in the transference, a kind of “stage performance” of the patient takes place, “acting out” the patterns of relations and behavior characteristic of him in interaction with the analyst, and then followed by the "stage interpretation" of the analyst.
The reconstruction of life scenes is also characteristic of psychoanalytic work with biography. The "archeology of the subject" is revealed by reconstructing the past by recreating the most important life scenes that determine the very structure of subjectivity. The reconstructed scenes of mother's love and tenderness are built into Leonardo's inner mental space, defining, in Freud's story, the features of the artist's mental image.
In one of his interpretations, J. Lacan outlines the pathography of André Gide [Lacan, 2002, p. 299-303], giving a vivid example of psychoanalytic "stage understanding". Lacan mentions Gide's specific homosexual fixation of desire, evidence of which he left on the pages of his diaries, the erotic nature of his reading and writing activities, the unusual relationship with his wife, and the special significance that Gide attached to correspondence with her. Revealing the meaning of these features (traces), Lacan reconstructs the psychobiographical scene in the light of which a number of the mentioned characteristics of the life world of the individual acquire their psychological meaning. 13-year-old André Gide, who experienced a clear lack of communication with his mother (who, according to him, appeared in and out of his life, and during periods of her presence, André felt lost and disoriented), faces a kind of seduction with side of his aunt. One day, coming to his cousin (aunt's daughter and his future wife), he finds his aunt there with her lover, and on the floor above - his cousin in tears, and at that moment, according to his own testimony, he experiences "a feeling of love, enthusiasm, sorrow, devotion and decides to dedicate himself to "protecting this child"
(cousin, his future wife, 15 years old). Lacan describes the scene from the point of view of the inner life of an experience that has left its mark (to live means to leave traces, in the words of W. Benjamin), reveals the meaning of the situation of seduction and subsequent betrayal, around which, ultimately, the core of the subjectivity of interest to Lacan takes shape. Lacan shows how in the scene with his aunt André Gide belatedly and not typically appears in the role of the desired child (remember, Busygina N.P. Psychoanalytic interpretation as a research strategy that his own mother often disappeared for years). Nothing could mitigate the trauma of seduction and betrayal, precisely because there was ground for seduction itself - an unconscious desire to be a desired child. In this situation, 13-year-old André, thanks to his cousin, identifies with the subject of desire, falling in love with someone who was once loved by his aunt (narcissistic fixation of desire on young men). And on the other hand, as a person, he can now develop in other relationships - in relationships with his cousin's wife; as a man and a writer, he can completely abide only in what he tells her (a special attitude given to correspondence with his wife), an undesirable woman becomes for him the object of the highest love.
As can be seen, in psychoanalysis the semantic structure of life scenes is reconstructed, life events are not simply recorded, but the internal history of experience is revealed through events.
It cannot be said that the causal relationship of events (scenes) and the observed mental appearance is traced. The events themselves exist in the context of a certain structure of subjectivity: history, as it were, reveals the meaning of this subjectivity, and at the same time we get the opportunity to understand history itself thanks to an understanding of the structure of subjectivity.
Techniques for recreating psychobiography through "unwinding"
life scenes that constitute the personality, bring psychoanalysis closer to literature. However, it can be assumed that psychoanalytic psychobiography gives rise to a special type of "psychological hermeneutics", which is practically not assimilated in the methodology of psychology. The methods of "genetic interpretation" discovered by psychoanalysis through the reconstruction of life scenes (and, above all, scenes associated with relationships with early objects) give psychologists one of the possible ways to go beyond unproductive explanations of behavior, relationships, etc. by referring to those or other properties in which aggressive behavior is explained by aggressiveness, the ability demonstrated by a person to endure a situation of uncertainty for a long time - tolerance for uncertainty, etc. A set of traits, “profile”
or the "psychogram" of a personality is not something to which it is enough to refer in order to understand anything in a personality. Freud discovers such a movement of thought, in which personality traits turn into the trace of history, cease to be a given, but appear as a “psychobiographical problem” in which history is “packed”. Life scenes, stories “unrolled” from individual personality traits “make it possible to comprehend as a project the internal coherence of the life world” [Lorentser, 1996, p. 180]. M.K. Mamardashvili demonstrates how the Theory and Methodology thinks through the idea of projects in a psychoanalytic spirit by J.P. Sartre, showing that the property of a person, which psychology often takes as the end point of an explanation, is nothing more than “a trace of past events, a product of fixing a certain dynamic” [Mamardashvili, 2010, p. 299]. If life scenes are “packed” in a certain property, through which a person, as it were, “understands the world and makes it possible for himself” (ibid.), then you need to “turn around the problem: take what we find on the surface as material, spinning which we can go back to what happened” [Ibid. P. 300] - to a set of life scenes. To do this, it is necessary to give meaning to the property, i.e., to consider it as a semantic formation - a symptom of something else.
The Symbolic Character of Psychoanalytic Language In The Dissatisfaction with Culture, Freud [Freud, 1992] offers a metaphorical analogy between the psychic world and some ancient city like Rome. The majestic city consists of many cultural layers, surprisingly coexisting with each other. More modern buildings find a place for themselves next to the traces of antiquity, the archaic takes on a different look, being included in a new architectural ensemble, and at the same time it seems to continue to live its own life, in turn determining what each new era brings with it. In the same way, the mental trace of the experienced continues to exist, being involved in complex connections with the newly experienced. And in this case, to understand the mental world means to find a language that would allow one to authentically describe experiences, including those that happened long ago, in the infantile period of life, but which left their mark that continues to exist.
As I tried to show above, psychoanalysis, along with phenomenology, "brackets" the external world, concentrating on the experience itself. M.K. Mamardashvili very accurately says that psychoanalysis, like phenomenology, proceeds from the premise of self-sufficiency in the accuracy of experience [Mamardashvili, 2010, p. 298]. There is an experience, an experience that communicates something that is not in the objective perspective of the world. “The problem of meaning (meaning not in the ordinary sense of the word) arises when we try, analyzing sensation and experience, to analyze it, remaining within its own framework, or, say, without transcending it, i.e. without leaving experience. to a certain world known outside the experience itself, but remaining inside this experience and believing that the world is born inside it for the first time” (ibid.). Oral sexuality, Oedipus complex, N.P. Busygin complex. Psychoanalytic interpretation as an investigative strategy of castration is all the components of that metaphorical language that allows one to grasp the living reality of experience, being, as it were, inside it. And since this language does not describe the objective content of experience, which may be true or false, it is meaningless to raise the question of verifying psychoanalytic descriptions by means of an external criterion. "Oedipus complex"
cannot be verified simply because it cannot be true or not true (just as a cultural myth cannot be true or false), it describes a reality in relation to which only the question of its meaning and function in the general organization of the psyche (as in relation to myth, only the question of its meaning and function in the organization of culture is possible).
A small child does not know what a "sex scene" is, does not know the relationship between parents, however, as Mamardashvili says, not knowing a child is by no means a void waiting to be filled, his misunderstanding is a productive misunderstanding, and what is experienced - irreversibly [Ibid. S. 328-329]. Just as the new Rome does not completely replace the archaic Rome, but the various cultural layers of the city continue to coexist with each other, the new, adult mental formations do not eventually take the place of infantile experiences, simply replacing them with themselves. It cannot be said that instead of infantile ignorance of sexuality comes its adult knowledge - this place is already occupied by the irreversibly experienced, and the dynamics of childhood experiences is preserved behind the façade of the so-called correct adult life. The dynamics of past experiences is such that it had meaning for the experiencer himself, and this meaning was fixed, “packed” in the formations of the unconscious, with which Freud works, as if “unwinding” them back to the meaning of the experienced scenes.
And the language of psychoanalysis is the language Freud found for describing these meanings of the experienced. And this means that it cannot be read naturalistically - as a designation of certain empirical essences or facts. In psychoanalysis, we are faced with a conceptual apparatus that has a “symbolic character” [Ibid. P. 353]: the language of psychoanalysis does not describe real events, but the processes of their mental processing and interpretation, and in this sense, the “oedipal complex” is not a representation of the real state of affairs, a fact, but an instrument of the inner work of experience, a “tool of interpretation” [Ibid. S. 344-348].
If the experience is irreversible and crystallizes in certain formations of the unconscious, then simply speaking about the experience, verbally reacting to it, is not enough. It needs to be re-experienced in a special kind of theory and methodology and situations of transference. But to relive does not mean simply to repeat, it means to process something in a different structural dynamic in order to disengage the bonds that have been formed. Psychoanalysis turns to the past in order to change fate [Kristeva, 2010], in order to unravel the crystallized meanings of the patient's past experience and, perhaps, give him the possibility of a different future.
*** Let me sum up some results. I have tried to show that in the psychoanalytic interpretation a special cognitive attitude is realized, the most characteristic features of which are the centering on meanings and the assumption of the self-sufficiency of experience, or experience.
In its “style of thinking”, psychoanalysis is close to phenomenological and hermeneutical approaches, at the same time it offers original methods of working with meanings that cannot be reduced to movement within the hermeneutic circle. Psychoanalytic psychobiography is an opportunity to capture the structure and dynamics of the deep layers of experience by means of symbolic language and thereby approach the description of that in the psyche that is inaccessible to classical objectivist methodologies.
The absence of an analysis of the methodological problems of psychoanalytic interpretation in the article is by no means an indication that, from my point of view, psychoanalysis is epistemologically flawless. Of course, this is not true. However, such an analysis is a separate task, taking into account the fact that a lot of criticism of psychoanalysis has long accumulated in the scientific literature and today a balanced analysis of the criticism itself is also needed.
Here it was important for me to outline the place of psychoanalysis in the range of humanitarian methodologies and to show, rather, not its problems, but its significance for the methodology of psychology. It should be recognized that the development of methods and methodologies in psychology has mainly followed the path of developing psychological experimentation, building up the arsenal of standardized methods, and complicating the methods of mathematical processing. However, in recent decades, psychology has become very actively involved in a number of interdisciplinary projects and areas of research, such as qualitative, visual, cultural, gender studies, studies of the body and corporeality, etc. And it was in the context of such interdisciplinary projects that the demand for non-classical types of methodologies that allow adequate grasping of new, complex, conceptually neo Busygina N.P. Psychoanalytic interpretation as a research strategy of limited objects. In this regard, I see as relevant a closer appeal of psychology not only to external methodologies created outside of it (as often happens in the framework of the direction of qualitative research in psychology, where, in particular, sociological methods are actively used), but also to methodologies that were discovered in the context of her own history. Psychoanalytic interpretation and psychoanalytic study of the case, as well as the psychoanalytic session in its not only therapeutic, but also research incarnation, is the most striking example of this kind of methodologies.
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PSYCHOANALYTIC INTERPRETATIONAS RESEARCH METHODOLOGY N. BOUSSYGUINA
The article is concerned with particular methodological features of psychoanalytic interpretation as a psychological research strategy. The main argument is that psy choanalysis tends to a special cognitive attitude based on the idea of self sufficiency of personal experience. The similar cognitive attitude is characteristic of the phe nomenological and hermeneutic approaches. The particularities of psychoanalytic psychobiography are described and the symbolic nature of psychoanalytic language is argued. The value of incorporating more psychoanalytic interpretation into scientific psychology is discussed.
Keywords: psychoanalysis, interpretation, classical and humanitarian methodologies, experience, meaning, psychoanalytic approach in qualitative research.
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Surely each of us has thought more than once about his life path, about what determines it. The concept of fate and belief in fate are probably familiar to every person. Fate is one of the most ancient universal concepts of our culture. The world-famous linguist A. Wierzbicka wrote: “People can not always do what they want, and they know about it. Their lives are shaped - at least to some extent - by forces beyond their control, and this seems to be a fact as obvious and universal as that they must die. Therefore, we have reason to believe that the concept of fate or something like that can be found in all cultures and that it finds expression in all languages - just as it happens with the concept of death.
In its most general form, the content of the concept of fate is traditionally reduced to the following. The life of an individual, like the life of a social collective as a whole, is not absolutely free. It is subject to the action of certain forces that determine (determine) the course of life events. The action of these forces in all their magnitude is not known to man, and he cannot predict the course of his life path. Thus, in the concept of fate, first of all, the fact of the existence of determining forces and the dependence on their actions, both individual events and the whole life of a person, the moment of unfreedom, is stated. The concept of fate also emphasizes the moment of fundamental unknowability of predetermining forces for a person. By the combination of these two signs - the presence of forces that determine something, and the unknowability of these forces, their closeness to the human mind - and recognize fate.
In European culture, there are opposite interpretations of the concept of fate. Within the framework of one of them, fate is understood as an external force in relation to a person, as an absolute predestination that excludes free will. In another interpretation, fate is presented as a product of the conscious creation of it by a person. This is reflected in numerous proverbs, for example, “if you sow an act, you will reap a habit; if you sow a habit, you will reap a character; if you sow a character, you will reap a destiny.” This is also referred to in the well-known Marxist slogan: "Man is the creator and master of his own destiny." The idea of fate is also associated with two different dimensions of human existence: biological and social. First of all, the concept of fate expresses the lack of freedom of a person before the limitations of his biological nature, ideas about fate are associated with birth and death. But, in addition to the objective lack of freedom of a person from his physical nature, there is also his dependence on social forces. This is the social environment in which a person is born, his professional and material status, political and religious worldview, upbringing, education, etc.
Psychotherapy and, in particular, psychoanalysis, argue that a person is to a certain extent a product of not only biological and social, but also mental determinations. Psychoanalysis has allowed us to take a fresh look at the driving forces behind our actions, at the reasons that prompt a person to do so and not otherwise. Unlike those who tried to find the cause of human behavior in the external environment that causes a response from the human body, Freud placed the force that determines the course of a person's life inside himself. In many ways, he turned the views on a person that existed before him, abandoning the usual idea that our thinking, desires and actions are arbitrary.
According to Freud, there are mental phenomena that are inaccessible to comprehension, but can not only influence our conscious ideas, actions and decisions, but even determine them. The conscious "I" is only the pinnacle of a powerful, unconscious mental life. The human psyche is to a greater or lesser extent governed by unconscious drives, impulses and desires. The iceberg analogy is often used to illustrate this point. If everything that is conscious is compared to the surface of the iceberg, then the unconscious will be associated with a much larger invisible mass of ice that is under water. It is this invisible mass that determines both the center of gravity and the course of the iceberg. Similarly, the unconscious is the core of our individuality. Unconscious psychic forces act on every person and to one degree or another predetermine many of his actions, which on the surface may seem to be the result of volitional decisions. A person may be convinced that he consciously decides which of the possible alternatives to choose. What he ultimately leans towards can be seen as the result of numerous factors, some of which are outside the realm of consciousness.
According to Freud, there are elements in the unconscious that have never been accessible to consciousness, respectively, they will never be conscious. In addition, there are contents that, due to their unacceptability, have been subjected to caesura and separated (displaced) from the field of consciousness. This material is not forgotten or lost, but it is never remembered. However, these contents indirectly affect consciousness. From a classical psychoanalytic point of view, repressed unconscious conflicts influence a person's behavior and well-being. The conflict in psychoanalysis is the existence in the inner world of a person of contradictory, sometimes opposite to each other, requirements. The conflict can be overt (for example, between a desire and a moral requirement) or hidden. The hidden conflict is distortedly expressed in a clear conflict - in symptoms, in behavioral disorders, in character difficulties, etc. In the classical psychoanalytic understanding, the participants in the conflict are sexual and aggressive drives that strive for satisfaction, and the demands of the outside world. Other basic human needs are now considered equally important. These are the needs for dependence, acceptance and attachment, on the one hand, and self-reliance, independence, autonomy, on the other hand, the need for power, control, self-expression. In order to resolve the conflicts between these needs, a person, often unconsciously, forms internal compromises. Some of them are quite adequate, others have a character that inhibits and restricts his freedom, leads to self-harm, to illness, and social failure. Symptoms, behavioral disorders, character difficulties are understood in psychoanalysis as similar "compromise formations".
The followers of Freud supplemented the theory of conflict with the theory of scarcity. In psychoanalysis, it is believed that the experience of all stages of life, including childhood problems, is present in a person's adult life and actively influences him. In many ways, we never get out of childhood. As to why we are unable to do this, there is no definitive answer. One possible reason is the long period of biological dependence of the human infant on the help of adults. It is also known that in addition to constitution and heredity, among the factors that have a decisive influence on development are our earliest experiences. This experience is present in us not so much in the form of memories of specific events and facts, but as certain stereotypes of thinking, behavior, emotional reactions, certain types of relationships with people.
Starting from childhood, our psyche can develop and strengthen only in relationships with other people, in communication, first with family members, then with peers. What is important is how the child's immediate environment, primarily the mother, builds relationships with him, how parents are able to fulfill their duties, whether they can meet the needs of the child, whether this helps the child's growth or makes it difficult for him. The way a mother feeds a child, touches him, how she adapts to his rhythms, how she reacts to his needs, is remembered by the child not in the form of words, but as physical sensations. This is something on the basis of which the primary trust in the world and ideas about security, self-respect and faith in one's own strength, and the ability to have stable close relationships are then formed.
Lack or mistakes in caring for a child, traumatic experiences in the early stages of development (sudden abandonment or death of one or both parents, gross hostile or sexual actions towards a child, accidents, serious illnesses) can leave an imprint on his entire subsequent life, distorting or hindering or even hindering the development of the child. So a tree planted in fertile soil, receiving enough moisture, light and heat, will compare favorably with its fellow, grown in harsh conditions - on poor soils, in a cold or arid climate.
Psychoanalytic practice speaks of the persistent desire of "forgotten" unconscious conflicts to penetrate into the present. They can take the form of dreams and symptoms, and determine the most important decisions in a person's life. Unconscious motives can influence how a person chooses an object of love for himself, takes on a certain task, starts some kind of business. At the same time, the person himself does not realize that he is repeating his previous experience, but is convinced that his behavior and well-being are completely conditioned by the present moment. Traumatic experiences, even those related to the past, can dominate a person's psyche for years. This leads to the fact that, with fatal inevitability, he will again and again fall into similar unpleasant situations, face the same conflict relations. Some men, for example, repeatedly fall in love and marry the same type of woman, although they know from previous experience that such a marriage will end in disaster. Similarly, certain women seem incapable of choosing men other than those who will offend, insult and humiliate them. Other people unconsciously arrange their lives in such a way that every success is followed by an even greater failure.
Freud writes that one might think of such people "that they are haunted by fate, that their lives are controlled by diabolical forces." He poetically compares this uncontrolled unconscious process, which he called obsessive repetition, with the inevitable return of a restless spirit, "which will find peace only when the mystery is solved, and witchcraft no longer dominates the soul."
The relationship between the patient and the psychoanalyst also testifies to the persistent desire of the repressed conflict for actualization. At the basis of all transference phenomena lies the phenomenon of repetition. In psychoanalysis, transfer is usually understood as the process of reproducing stereotypes of thinking, behavior, emotional reactions, which leads to the establishment of a certain type of interpersonal relationship. At the same time, the patient's previously inherent feelings, fantasies, fears, methods of protection that took place in childhood and related to significant parental figures are transferred to the analyst. The observation of repetition in the transference, on the one hand, leads to a reconstruction of the origin of the disease, and on the other hand, to an emphasis on memories as a healing factor.
The model of the analytic process found its expression in Freud's triad of "recollection, reproduction, elaboration". Working through constantly takes place during treatment and is a psychic work through which the patient accepts certain repressed contents and thus frees himself from the power of the mechanisms of repetition. It allows "... to overcome the force that compels repetition, or, in other words, the attraction of unconscious prototypes that act on repressed drives." Working through, assisted by the analyst's interpretations, acts as a process capable of stopping the persistent repetition of unconscious formations, bringing them into connection with the patient's personality as a whole.
For example, if a patient treats a male psychotherapist like her father, outwardly submissive and respectful, but in a veiled form of hostility, the psychoanalyst can explain these feelings to the patient. He can draw her attention to the fact that it is not he, the therapist, who causes these feelings, but they arise in the patient herself and reflect the unconscious aspects of her relationship with her father.
The transference phenomenon is crucial in the psychotherapeutic process, since the transference translates past events into a new context that is conducive to their understanding. Psychotherapy helps to at least partially free oneself from the power of the mechanisms of repetition. In the course of psychotherapeutic treatment, the patient can achieve a better understanding of his formation, the main conflicts and obstacles along the way, make up for developmental deficiencies, and develop new, more adequate ways of interacting with the outside world. Such "self-knowledge" not only alleviates suffering, it changes the whole character of a person. The patient is now able to better solve emerging problems, to make flexible choices, and is less likely to fall under the control of old, inadequate ways of responding. This is experienced as liberation, spiritual liberation, previously closed paths and horizons are opened, ordinary life now brings more satisfaction. It can be said that psychotherapy enhances a person's ability to control their destiny and their happiness, although, of course, this is not a miracle cure for all problems.
Psychoanalysis as a method of treatment of neuroses
Psychoanalysis is a tool that enables the ego to achieve progressive victory over the id.
A review of psychoanalytic theories gives a general idea of psychoanalysis as scientific knowledge, but leaves open the question of what the work of a psychoanalyst is. This chapter is devoted to a discussion of the methodological aspects of psychoanalysis. In describing the psychoanalytic technique, we relied primarily on the works of Z. Freud, E. Glover, O. Fenichel, R. Greenson, H. Tome and H. Kahele, O. Kernberg, M. M. Reshetnikov, A. I. Kulikov, as well as personal experience in training analysis (training analysis by certified analysts) and my own long-term practice of psychoanalytically oriented psychotherapy.
Psychoanalysis can rightfully be attributed to one of the most technological areas of modern psychology, since the question of the method of treatment has always been and continues to be its central theme. Organized in 1957 in Paris (as part of the 20th Congress of the International Psychoanalytic Association), the discussion “Varieties of Classical Psychoanalytic Technique” convincingly demonstrated the diversity of points of view regarding the therapeutic procedures used by psychoanalysts. Nowadays, the term "psychoanalysis" is applied to various methods, often based on the personal preferences of their authors.
In connection with the existing differences in modern psychoanalysis, two main options are distinguished - classical technique and psychoanalytic therapy, which adjoin dynamic psychiatry and psychodynamic psychotherapy. In relations between individual groups, marked factionalism, closeness, up to mutual rejection, are noted. Analysts are reluctant to openly discuss their practice for a variety of reasons, including the highly confidential therapeutic relationship with the patient and the complex countertransference (arising in response to the patient's reactions) feelings of the therapist himself. And although the necessary consolidation of the psychoanalytic community has not yet been achieved, between the listed approaches initially there is common working platform, the main provisions of which are discussed below using the example classical psychoanalysis and psychoanalytic therapy.
Psychoanalysis emerged as a method of studying and treating neuroses. In the previous sections, it was shown that, in accordance with the structural theory psychoneuroses are based on a neurotic conflict - a clash between the impulses of the Id, striving for discharge, and the defenses of the Ego, which prevent both unwanted actions and the access of painful material to consciousness. The external world also plays an important role in the formation of neurosis, but in order for a neurotic conflict to arise, it must be experienced as an internal contradiction between the derivatives of the ego and the id. The superego performs a more complex task. This instance makes instinctive impulses and socially disapproved actions forbidden for the Ego, causing a painful feeling of guilt even for a symbolic discharge. The ego has to constantly expend energy to keep dangerous tendencies from reaching consciousness. The ego becomes less and less able to cope with increasing tensions and eventually becomes overwhelmed by them, passing into a state of "congestion". Involuntary discharges are experienced by a person as a decrease in conscious control, and clinically as symptoms of psychoneurosis. The term "neurotic conflict" is used in the singular, although every patient has more than one conflict at every stage of life.
In the process of accumulating clinical data, Freud repeatedly made changes to his own method of treating neuroses. At the very beginning, he limited himself to using the generally accepted therapeutic procedures of the time - electrical stimulation, hydrotherapy, massage, etc. Not satisfied with the results, in 1887 Freud began to use hypnosis, having learned this from Jean-Martin Charcot.
Psychoanalysis owes its origin in the form in which we know it to Josef Breuer's cathartic method based on the discovery that the hysterical symptom disappeared whenever the patient could remember the event that triggered the symptom. The therapist hypnotized the patient and tried to make him remember the traumatic event in order to induce a healing catharsis (clearing). Anna O., who was treated by Breuer from 1880-1882, had spontaneous hypnotic trances during which she relived past traumatic events, resulting in partial healing. Thus, Anna O.'s experience paved the way for a method of cathartic therapy, which she herself called "talking cure" or "pipe cleaning".
In the case of Emma von N. (1889), Freud first used hypnosis to achieve catharsis. His therapeutic approach was as follows: he hypnotized the patient and ordered her to tell the origin of each of her symptoms. He asked what frightened her, what caused her to vomit, or made her sad when those events took place, etc. The patient responded with a series of memories, often accompanied by strong affect. At the end of the session, Freud suggested to the patient that she forget the upsetting memories.
By 1892, Freud realized that his ability to hypnotize patients was limited. He recalled how Bernheim had demonstrated that patients could be induced to recall forgotten events simply by waking suggestion. Freud came to the assumption that patients knew everything that was pathogenic to them, and it was only a matter of getting them to say it. He suggested that patients lie down, close their eyes and concentrate. He pressed his forehead and insistently said that the memories should appear. Elisabeth von R. (1892) was the first patient Freud cured by suggestion while awake. By 1896 he had completely abandoned hypnosis in favor of waking suggestion.
It is not entirely clear when Freud moved away from using suggestion as a primary therapeutic tool. As a result of his work with dreams, Freud was able to rely more and more on free associations- spontaneous production of material by the patient. E. Jones describes the case when Freud persistently questioned Elisabeth von R. and she reproached him for interrupting her train of thought. Later, Freud followed her advice, which meant abandoning the method of suggestion and moving to the technique of free association. Freud himself described the procedure he discovered as follows: Without exerting any pressure, the analyst invites the patient to lie comfortably on the sofa, while he himself sits in a chair behind him, out of the patient's field of vision. In order to achieve ideas and associations, the analyst asks the patient to “allow themselves to enter” into a state “as if they were talking aimlessly, incoherently, at random”» .
In 1896, in the article "On the Etiology of Neuroses", Freud introduced the concept of "psychoanalysis" into scientific use. In the course of further work, he formulated the basic principles and provisions of the method, which we today call classical psychoanalysis, or simply analysis.
Free association procedure constitutes the basic rule of psychoanalysis, which is that the patient must say whatever comes into his mind (without shame, fear of negative evaluation or the desire to make a good impression). It is the only method of communication for patients during psychoanalytic treatment. On the part of the analyst, however, the most important tool from the time of Freud to the present day continues to be interpretation. These two technical procedures, free association and interpretation, set psychoanalytic therapy apart from many other methods. Other modes of interaction are used as auxiliary means, but are not basic and typical of classical psychoanalysis.
One of the theoretical "pillars" of psychoanalysis is the proposition that neurotic conflict originates in the early period of the individual's life, as a result of which a backward movement is required to resolve it. In this regard, the phenomenon of regression is of particular importance for therapy. According to modern views, regression refers to a return to a less mature level of mental development. In other words, this is the emergence of that mode of functioning that was characteristic of the mental activity of the individual in the early stages of his development. Many forms of regression appear only temporarily and are reversible.
Freud introduced the concept of regression in his study of dreams in connection with the topological model of the mental apparatus formulated by him: “ We speak of regression if, in the dream, the representation is again transformed into the sensory image from which it once arose.» .
With regard to psychoanalytic treatments, Freud wrote in 1914 about how the discovery of the mental process, which he later called regression, significantly altered the development of analytic technique. " We directed the patient's attention directly to the traumatic event during which the symptom first appeared, tried to unravel the mental conflict in it and release the repressed affect.» .
Another important technical point is that the relationship between patient and doctor is recognized as the main therapeutic factor in the process of psychoanalytic therapy. Freud noted: The first goal of treatment remains the task of placing him [the patient] towards treatment and towards the personality of the doctor. Nothing else can be done for this than to give the patient enough time. If serious interest is shown in the patient, the various manifestations of resistance that appear at the beginning of the treatment are carefully eliminated and obvious blunders are avoided, this disposition appears in him by itself; in his imagination, he ranks the doctor among those persons in whom he is accustomed to seeing manifestations of love» .
An even more important psychoanalytic concept and at the same time a therapeutic factor is working alliance. R. Greenson characterizes the working alliance as a relatively non-neurotic, rational direct contact between the patient and his analyst. This intelligent part of the patient's emotions directed at the analyst creates a working alliance distinct from the transference neurosis. The actual manifestation of the working alliance consists in the willingness of the patient to carry out various psychotherapeutic procedures, in the ability to work analytically with those insights that are caused by regression or cause suffering.
For the analysis to be successful, the relationship between therapist and patient must be transformed into a working alliance. An alliance is formed between the patient's conscious ego and the analyst's analyzing ego. This is an important condition for successful analysis, since rational attitudes allow the patient to trust and cooperate with the therapist, despite the disorganizing influence of intense "irrational" transference reactions. An important milestone in the progress of the working alliance relationship is the temporary and partial identification of the patient with the attitude of the analyst and his methods of work, which the patient begins to apply during therapeutic sessions. R. Greenson emphasizes that the patient's ability to form relatively soft, that is, desexualized and devoid of aggression, relationships depends on the presence of patterns of this kind in his past experience. This does not mean that any negative feelings should be absent from the working alliance. The threat to analysis is not feelings in general, but a hard-to-control breakthrough of drives that cannot be compromised, do not tolerate frustration and strive to establish themselves in analysis, thus displacing the conscious goals of therapy, replacing them with themselves.
Freud recognized that, under certain conditions, the relationship of the patient to the doctor can be disturbed, creating resistance- the "worst obstacle" to therapy. This can happen if the patient feels neglected, becomes sexually dependent, or endure on the figure of a doctor experiences from his past. Manifestations of resistance and transference should be brought to the conscious level, after which it is necessary to encourage the patient to communicate, despite his conflicting feelings. Thus, Freud discovered the phenomena of resistance and transference, regarding them as interferences in the therapeutic work. At the initial stages of its development, psychoanalysis was aimed at the restoration of traumatic memories, followed by the reaction of painful experiences and the achievement of catharsis, in connection with which the reactions of transference and resistance had to be bypassed or overcome.
Gradually, Freud moved from symptomatic therapy to a complex analysis of neurosis. He no longer tried to clarify each symptom, but suggested that the patient himself choose the topic of the session, starting the therapeutic work with the obvious manifestations of the unconscious at the moment. A new emphasis was now placed on making the unconscious conscious, removing amnesia and recovering repressed memories. Resistance has been correlated with the forces that cause repression. Hypnosis and suggestion should be avoided, as the latter mask resistances and hinder the discovery of the psychic forces at work in the patient. If resistance is ignored, only incomplete information can be obtained and temporary therapeutic success can be achieved. The analyst must use the art of interpretation in order to overcome resistance and eliminate repression.
In 1905, Freud first emphasized the crucial role of transference. " Transference, which seems destined to be the greatest hindrance to psychoanalysis, becomes its most powerful ally if every time its presence can be discovered and explained to the patient.» .
Since 1912, the sequential analysis of transference and resistance has become a central element of the therapeutic process. Freud warned against transference gratification (the analyst's withdrawal from the therapeutic relationship by involving him in the patient's habitual transference relationship), for which he suggested that the therapist be impenetrable and maintain his anonymity. In his Lectures on Introduction to Psychoanalysis, Freud attempted to uncover the relationship between acting out, transference, and resistance, showing that these therapeutic processes arise without the patient's consciousness (automatically) as a result of compulsive repetition.
Freud used the term "transference neurosis" to mean that during psychoanalysis the patient projects his previous conflicts and experiences onto the personality of the analyst, playing out his habitual relationship scenarios. This process is made possible by the fact that the patient knows little about the therapist, who takes a relatively neutral and anonymous position. As a result of the anonymity of the therapist and the tendency to compulsively repeat the patient, the latter develops a transference neurosis - a kind of repetition of childhood neurosis.
Freud recognized that in the analysis of the transference, a restructuring of the ego becomes possible. Thus, in the course of the development of the psychoanalytic method, acting out ceased to be the main task of therapy and the attention of the analyst shifted to the area of transference and resistance. The ultimate goal of psychoanalysis was to increase the relative strength of the ego in relation to the superego, the id, and the external world.
Describing the technique of psychoanalysis, R. Greenson uses two basic concepts - technical procedure and therapeutic process. A technical procedure is understood as: techniques, tools, actions and means used by the therapist or the patient in order to facilitate the therapeutic process. Hypnosis, suggestion, free association, interpretation are examples of the technical procedures used by Freud in the early stages of psychoanalysis. The term "therapeutic (analytical) process" is used in relation to interrelated events occurring within the patient during therapy. Regression, reaction, restoration of repressed material, insight - therapeutic processes.
Analysis differs from other methods of psychotherapy in its specific requirements and limitations. Analytical situation is determined by the fact that therapy occurs under given conditions, at a certain time and with a certain frequency (in the classical version, 4-5 times a week). These conditions encourage analytical process, which contributes to the emergence of a temporary regression in the patient, in which previously unconscious (repressed) memories, forbidden childhood desires and fantasies are awakened.
Carrying out therapy in conditions when the patient is in the supine position and as relaxed as possible, and the impact of external stimuli is minimized, is best suited to direct the patient's attention to his inner state, to the inner space of his experience. By positioning himself outside the patient's field of vision, the therapist facilitates the development of transference fantasies already embodied in him, directed towards the therapist's personality, without obstructing them by his real presence. Thanks to this arrangement, the attention of both participants in the analytical process is directed to the patient's inner world. This arrangement also means the exclusion of non-verbal communication (facial expressions and gestures), which often becomes the subject of criticism by opponents of psychoanalysis.
In addition to the setting, the therapeutic contract, which consists in reaching a clear agreement on the real conditions in which the treatment is carried out, serves to understand the hidden material. So, at the beginning of therapy, the expected duration of treatment, the frequency and duration of sessions, the type of financing, special financial issues (payment for a session in case of missing a meeting without prior warning), limits of what is permitted, and more should be agreed.
Compliance required for the therapist abstinence rules(withdrawal symptoms) means that he, in turn, refuses to satisfy the desires of the patient, for example in personal information about the therapist or a closer relationship with him. The neutral position of the therapist makes it possible to reduce the manifestations of acting out (repetition of previous patterns of behavior), to reveal the transference and to verbalize the fantasies and experiences of the patient. The psychoanalyst's neutrality requires effort, especially in the early stages of therapy, when the patient learns to accept its rules and limitations, involuntarily trying to induce the therapist to act according to his "rules".
H. Tome and K. Kehele, noting the debatable nature of the issue, divide modern therapeutic methods into specific and non-specific means. Examples of specific analytical tools, according to the authors, are: insight, interpretation of transference and resistance, confrontation, clarification, reconstruction of the personality through the recollection of past experiences. At the same time, the authors analyze numerous "non-specific approaches", including therapy based on emotional experience (Ferenzi, Rank, Kohut), in which the emphasis is on satisfying the patient's narcissistic needs and compensating for deficits in his object relations. The authors come to the conclusion that there is no antagonism between the listed means, that they complement each other, and their application depends on the situation.
According to R. Greenson, work techniques can be divided into analytical, non-analytical and anti-analytical.
The analysis uses four basic analytical procedures: confrontation, clarification, interpretation and elaboration. At the same time, various authors unanimously recognize interpretation as the most important technical procedure of psychoanalysis, ensuring the achievement of its main goal - increasing the patient's ability to understand himself.
Confrontation usually constitutes the first step of the analysis. Confrontation takes place whenever the therapist helps the patient to discover some fact (phenomenon), which must subsequently become conscious. For example, the therapist may draw the patient's attention to avoidance of a topic, or being late, or specific contradictions in his story, or recurring events in his life. Gradually, the patient ceases to deny obvious facts, defining for himself previously unconscious conflict zones.
Once the phenomenon to be avoided becomes "visible", one can proceed to clarification significant details: in what situations this or that action is manifested, what it leads to, how exactly it happens, how others react, etc. This technical procedure requires patience and delicacy from the analyst, who should not rush and always follow the patient , using every opportunity to clarify important details. After confrontation and clarification have been carried out to a sufficient extent for the patient (provided that the therapeutic alliance and controlled resistance have been achieved by this point), the patient is prepared for the main procedure of analysis - interpretations. R. Greenson emphasized: “ To interpret means to make an unconscious phenomenon conscious. More precisely, it means making conscious the unconscious meaning, source, history, form, or cause of a given psychic event. This usually requires not one, but several interventions.» .
An interpretation may be offered in the form of a suggestion, a statement, a question, or a metaphor. In psychoanalysis, three main types of interpretation are used: genetic, symbolic and structural. In the first case, the phenomenon is analyzed in the context of the client's infantile experience. For example, when discussing situations in which a patient loses control over drinking, the therapist might suggest: “You seem to have an uncontrollable urge to drink whenever you feel rejected, similar to how you used to hide in the closet and eat candy when you were a child. your parents left you alone. In a symbolic interpretation, the hidden meaning of a symptom or other phenomenon is discussed, for example: “On a symbolic level, alcohol becomes an object for you that ideally takes care of you - soothes, supports, warms.” In turn, structural interpretation involves the analysis of the phenomenon through the prism of the interaction of three mental instances. It may look, for example, like this: "Alcohol becomes the only measure by which you can reduce anxiety and reconcile your aggression towards loved ones and guilt towards them."
For interpretation, the analyst uses his own unconscious, his empathy and intuition, as well as deep theoretical knowledge. Interpretation generates insight - an instant “insight”, a guess, a new vision that connects unconscious manifestations and conscious facts into one whole. Through systematic insights, the desired understanding and integration of the various parts of the patient's ego occurs.
The fourth step in analysis is elaboration. This is the kind of analytical work that aims to deepen understanding and create the conditions for real change. Working through is primarily concerned with a detailed study of resistances - that which prevents the achievement of desired changes. It also involves an in-depth exploration of intrapsychic conflict, anxiety, defenses, and transference reactions. Part of the work is done by the patient outside the sessions. Processing requires the most time compared to other psychoanalytic procedures. Insight does not lead to immediate changes in behavior. Rapid changes are usually short-lived. It usually takes a long time to overcome significant forces that resist change and create strong structural shifts. The listed procedures can follow one another in any order, depending on the characteristics of the patient and his ability to perceive interpretations.
Non-analytic procedures are also used in analysis, for example in the initial stages or as preliminary measures to solve major problems. So, in the course of acting out, in accordance with another terminology - "acting out" (repetitions in therapy of habitual unproductive patterns of behavior), the patient achieves a certain discharge of drives, partially freeing the Ego and "clearing the way" for the subsequent insight.
Anti-analytic procedures are those that block or reduce the capacity for insight and understanding. As such actions, one can name the prescription of certain medicines and intoxicants, advice, quick and easy consolation, some types of patient transference satisfaction, distraction, etc. .
The displeasure that arises in therapy can only be endured by the analysand when his relationship to the analyst is colored positively, that is, when he re-experiences in the analyst the early object from which, according to Freud, he was "accustomed to receiving love." In other words, there must be a relationship of sufficient trust between him and the psychoanalyst for a relationship of expectation of a healing change to take place. Without such hope, the analyzed person will not be able to fully engage in the rather laborious psychoanalytic process and achieve the expected success in solving the tasks set.
Since analytical work is determined by specific analytical goals, analysis cannot be "infinite". As the symptoms resolve, the end of treatment becomes possible. Completing the analysis is not easy. H. Thome and H. Kehele point to various dramatic collisions that lie in wait for the analyst and the patient in the final phase of therapy. Negative manifestations include: interruption of therapy by the patient without reaching mutual agreement; disappointment in the work on one or both sides and the depreciation of its results; the inability of the patient to separate from the therapist; the therapist's desire for too long treatment for a "complete" resolution of the transference neurosis, and others.
In the most favorable variant, the question of the termination of therapy should be the result of mutual agreement. In his 1937 work Finite and Infinite Analysis, Freud formulated two basic conditions necessary for the completion of analysis: First, the patient must no longer suffer from his symptoms and must overcome his anxieties and inhibitions; and secondly, the analyst must come to the conclusion that so much of the repressed material has come into consciousness, so much of what was unintelligible has now been explained and so much of the internal resistance has been conquered that there is no need to fear a repetition of the associated pathological processes.» .
Recognizing the importance of Freud's remarks, different authors have different criteria for completing treatment. The latter include: structural changes that have arisen due to the deep processing of unconscious conflicts; increasing the patient's ability to introspection; ability to cope with anxiety; the ability to understand oneself and achieve the necessary changes; increasing the ability to focus on the requirements of reality; resolution of transference neurosis.
Thus, in the most general form goal of psychoanalysis defined as an increase in the patient's conscious control over his own mental life. The transference neurosis that arises in the analytic process enables the analyst to understand what the patient's attitudes, feelings, conflicts, and compromise formations manifest as remnants of repressed impressions, relationships, and traumas. The analyst interprets the presented material, thereby bringing it to the consciousness of the patient, causing his insights. In the course of long-term treatment (from one to five to seven years), the identified unconscious products are processed, integration of the past with the present is achieved, eliminating the limitations (symptoms) caused by unconscious conflicts. The analytic situation presupposes a stable system within which the patient and the analyst mutually mobilize intrapsychic processes that impel the patient to change as the tension that arises in him is monitored and interpreted by the analyst.
The main therapeutic factors that ensure the success of therapy include: therapeutic relationship and limitations, free association and dream analysis, analyst interpretations and patient insights, analysis of transference and resistance, therapist neutrality, and increased patient sense of reality. The attainment by the analysand of an ever higher level of ego maturity through the formation of a transference neurosis and its working through in the analytic situation can be seen as the essence of analysis.
Transference, resistance and countertransference
Overcoming resistance is the part of our work that requires the most time and effort. However, it is worth it, as it leads to a favorable change in the Self.
The concepts of "transference", "resistance" and "countertransference" constitute the main theoretical and methodological basis for psychoanalytic therapy and require additional discussion.
As noted above, under transfer (transfer) in psychoanalysis understand " the transfer of feelings, thoughts and behaviors, originally related to significant people from childhood, to a person included in current interpersonal relationships» . In other words, it is the reproduction in the analytic situation of significant (positive, negative or traumatic) relationships from past experience, and above all with parental figures. This phenomenon is predominantly unconscious and determines the essence of the analytic situation. Obvious signs of transference are the inadequacy of the patient's feelings in relation to the actions of the analyst and the analytical situation, the excessive intensity of the patient's experiences, the clear similarity of actual mental manifestations with feelings, thoughts and actions in the past.
According to the predominant experiences in the transference, they distinguish positive transfer with the dominance of positive feelings of the patient, eroticized- filled with explicit sexual fantasies and experiences, negative- with a predominance of aggressive-destructive drives and affects. In practice, various variants and combinations of the listed forms often take place: complex mixed, ambivalent, or alternating, transference patterns. Obviously, such a classification is simplified, nevertheless it is generally accepted.
R. Greenson, like A. Freud, proposes to correlate transference patterns with the stages of psychosexual development: “ This means that we can categorize the patient's reactions to his analyst in terms of instinctive goals, instinctive zones and anxieties, attitudes and values according to these instinctive components.» .
For example, oral transference will manifest itself as an exaggerated attention to every word and look of the analyst, the desire to "absorb" as much as possible, insatiability, fear of separation, fear of being abandoned, jealousy of other patients (as well as relatives and other occupations of the therapist). At the same time, the patient clearly manifests feelings of love and hatred, trust and distrust, as well as such oral defenses as introjection, splitting, projective identification, acting out habitual patterns of behavior.
Other grounds for classifying transfer can be the correlation of the latter with the structures of the id, ego, and superego. In this connection, the transference of the “punishing super-ego” type, in which the patient projects onto the analyst the hostility and fear that he experienced in relation to parental figures before they were clearly separated from his ego, presents particular difficulties in analysis. come to life in transference due to insufficiently formed boundaries of the Self-Other, due to the action of primitive mechanisms of splitting and projective identification.
In all these cases, the success of therapy depends on the ability of the therapist not to engage in transference relationships, to refrain from responding to the patient's projections. The analyst should strive to maintain a friendly working relationship. The ability to persist, despite the destruction produced by the patient, is the basis of the containment technique (V. Bion), the use of which allows the patient to return everything that he “spewed” from himself to the therapist, but in a significantly softened, purified form, without causing excessive anxiety.
Thus, transference reactions represent the revival of unconscious conflicts of the past in the situation of analysis. The repetition of infantile impulses and defenses in the relationship with the analyst contributes to the manifestation of the actual content of the neurosis and other psychopathological features. This circumstance allows us to consider transference as a central analytical process and a specific feature of psychoanalysis. The therapeutic effect is achieved as the transference is revealed, the patient's gradual awareness of his own transference reactions, their elaboration in the course of therapy until partial or complete liberation from his power is achieved.
Another key concept and at the same time an analytical process is resistance, or anything that hinders analytical work. In "Lectures on Introduction to Psychoanalysis" Z. Freud wrote: " If we strive to cure the patient, to free him from painful symptoms, then he puts up a fierce, stubborn resistance to us, lasting throughout the entire treatment.» .
The question of the origin of resistance was not entirely clear to Freud. He believed that the main source of resistance is the desire of the Ego (I) to avoid anxiety. In addition to the resistance of the ego, the obstacle to therapy also comes from a certain deep resistance of the id, about the essence of which Freud expressed various hypotheses, emphasizing, however, its irreducibility to psychodefences.
In Inhibition, Symptom, and Fear (1926), Freud named five forms of resistance. Three of these are self-related: repression-resistance, transference-resistance, and the phenomenon of secondary benefit from disease. Two other forms: id-resistance and super-ego resistance.
1. resistance-displacement associated with the need of the individual to protect himself from impulses, memories and sensations, which, if they penetrated into consciousness, would cause a painful state, or at least the threat of its appearance.
2. Transfer resistance(transference resistance) reflects the struggle against infantile impulses that have arisen in direct or modified form as the patient's reaction to the personality of the analyst.
Freud first described transference as a resistance and a major hindrance to therapy. Subsequently, the understanding of transference has changed from being seen as an impediment to work to being the most powerful therapeutic tool as long as it does not become a negative or overly positive or eroticized transference. These two forms of transference, as Freud said, become resistance when they interfere with the process of remembering.
In general, the concept of transference resistance includes resistance to the awareness of the transference, resistance in the form of transference love or negative transference, and resistance to the resolution of the transference. Transference-resistance includes the patient's conscious concealment of thoughts about the analyst, as well as unconscious transference thoughts, from which his psyche seeks to defend itself.
R. Greenson highlights the following resistance-transfer options. First of all, this search for transference satisfaction. The simplest and most common sources of transference resistance occur when the patient develops strong emotional and instinctive urges towards the analyst and seeks to satisfy them more than to do the analytic work. For many patients, the source of resistance is the desire to be loved. This desire can block and crowd out therapeutic goals. The fear of losing love and respect from the therapist is always a source of resistance to work. There are also patients with strong destructive impulses who unconsciously seek to destroy the analyst and analysis instead of analyzing their conflicts. Another option for transfer resistance is defensive reactions, which manifest as habitual behaviors in difficult situations, such as rationalization, sexualization, or projection. Transference defenses are associated with fear of some instinctual urge or affect, such as depression or guilt. Generalized transfer reactions is another form of resistance. In this case, the patient reacts to the analyst in the same way that he reacts to many or most people in his life. This behavior is typical and habitual. This behavior was called "characteristic transference" by Reich. Greenson, on the other hand, believes that the definition of such transfer reactions as "generalized transfer reactions" is more accurate, since the term "characteristic" has other meanings. Acting Out Transference Reactions- the fourth variant of transference resistance - manifests itself under the influence of an obsessive desire for repetition. In this case, the obstacle may be: strong experiences from the past, symptomatic behavior (for example, drinking alcohol), acting out sexual desires outside of therapy.
H. Tome and H. Kahele point out that the specific forms that the various elements of transference resistance take depend on the characteristics of the patient and on the analyst's interpretations. For example, a paranoid patient quickly develops a negative transference, while a nymphomaniac develops an eroticized one. The intensity of these forms of transference makes them resistance. Between the transference that is useful for the treatment and the transference that destroys it, there is a wide range, and within it the analyst decides which forms of behavior to interpret as resistance.
3. Resistance as a result of the secondary benefits of the disease also widespread. The symptom is a compromise formation that reduces anxiety, thereby providing primary gain from illness. Secondary win is the ability to influence or control others through illness. For example, the primary payoff in agoraphobia (fear of open spaces with refusal to go out) is a distraction (liberation) from the anxiety associated with ambivalence to parental figures, and the secondary payoff is the ability to avoid unpleasant duties or get others to accompany you everywhere. The relatives of the patients are in fact aware of the secondary gains of the neurosis, but remain ignorant of its original sources.
Typical manifestations of such secondary advantages are the benefits derived from illness, the advantage of being in the position of the sick and being the object of the cares and pity of others, as well as the satisfaction of aggressive and vengeful impulses that arise in relation to those who are forced to share the suffering of the sick. Secondary benefits may also be felt by the patient as satisfaction of his need for punishment or hidden masochistic tendencies. In some cases, this may be the desire to receive benefits and benefits guaranteed by society in case of illness. The difficulty of parting with these secondary advantages of one's illness constitutes a special form of resistance.
4. Resistance-Id is the resistance of the instinctive impulses to any change in their mode and form of expression. Difficulties arise when an instinctive process that has flowed according to a certain pattern for decades is suddenly forced to take a completely new path. To eliminate this form of resistance, what Freud called elaboration. Sandler believes that this type of resistance can be seen as a consequence of a more general psychological resistance to the rejection of previously acquired habitual patterns of functioning. In this regard, one of the aspects of working out may be the process of learning new patterns of functioning and ways to suppress, restrain old, more stable behavioral patterns.
5. Superego Resistance stems from the patient's guilt or need for punishment. Freud believes that this kind of resistance is the hardest to detect and the hardest to deal with. Thus, a patient who experiences an unconscious sense of guilt about certain sexual desires may react with strong resistance to the situation of uncovering and releasing these desires in the course of analytic therapy. The so-called negative therapeutic reaction (deterioration of the patient's condition during treatment) can be considered as the most intense form of resistance to the Super-Ego.
Sandler considers it important to distinguish between the internal mental state of resistance and the observable signs of resistance, which are usually called "resistance". Glover (1955) describes "gross" (obvious) and "slight" resistances. Obvious resistances include interruptions in treatment, tardiness and omissions, silence, avoidance of direct questions from the therapist, automatic rejection of everything the analyst says, showing incomprehension, distraction, and falling asleep. Less pronounced resistances hide behind a façade of outward acceptance of the demands of therapy. This may take the form of formal agreement with everything the analyst says, willingly providing necessary material (such as a description of dreams) in which the patient appears to be interested in the analyst, and in many other forms.
Of great clinical importance is the allocation of ego-synthonic and ego-dystonic resistances. Ego-dystonic resistances are experienced by the patient as hindering the success of therapy. Ego-synthonic ones are felt not as resistances, but as some kind of normal manifestations. As a rule, at the beginning of the analysis, one works with ego-alien resistances, after this preliminary work and the formation of a therapeutic alliance, a transition to work with ego-synthonic resistances becomes possible.
Discussing the general factors of resistance, H. Tome and H. Kehele note the following:
Resistance refers to a consciously desired change that is unconsciously fearful;
Resistance manifests itself not so much in slips of the tongue, mistakes, and other unconscious productions, but in the relationship between therapist and patient;
Therapy suffers if resistance exceeds a certain level of intensity, which can be reflected in a wide range of phenomena (intensification of transference to the point of reckless passion is just as dangerous as over-rationalization in therapy);
In assessing resistance, it is necessary to use quantitative-qualitative criteria, for example, a positive or negative transfer becomes resistance if it reaches an intensity that blocks intellectual cooperation.
Ignoring patient resistance in any form destroys therapy. Despite the fact that interpretation is recognized as the main analytical procedure, it is not always accessible and useful to the patient. In order to save the patient from repression, it is not enough to explain the meaning of his symptoms, but first of all, his resistance must be overcome. Freud emphasized that in connection with this the main features of analytic technique are the interpretation of transference and resistance.
For this work to be successful, certain rules must be observed. O. Fenichel gives the following recommendations: 1) always start interpretation from the surface; 2) allow the patient to determine the topic of the session; 3) interpret the resistance before interpreting the content; 4) avoid both too rough and too superficial interpretations. Typical mistakes that increase resistance can be: premature (hasty) interpretation; interpretation of the material without taking into account the characteristics of the patient; unsystematic interpretation of transference; conflicting interpretations.
R. Greenson offers the following resistance analysis logic:
1) recognize resistance;
2) demonstrate it to the patient in case of occurrence (confrontation);
3) clarify the motives and forms of resistance (what specific painful affect makes the patient resist; what specific instinctive impulse is the cause of the painful affect; what specific form and method does the patient use to express his resistance);
4) interpret the resistance (in terms of the fantasies or memories behind it, in terms of the patient's history of past and present relationships);
5) interpret the form of resistance (analyze the forms in the present and the past; trace the history and unconscious goals of this activity);
6) carefully work out (repetition and deepening of steps 4 and 5).
The success of overcoming resistance depends on the therapist's ability to work with resistance and his ability to strengthen the therapeutic alliance. In order for the patient to be able to trust the analyst and have no doubts about the success of the analysis, the analyst must transmit sufficient warmth, sincerity and empathy. Empathy is the main source of therapeutically accurate and useful interpretations.
To perform these tasks, the analyst must be aware of his own emotional reactions and unconscious processes that arise in the course of therapy. They are usually based on countertransference - "a situation in which the analyst's feelings and attitudes towards the patient are derivatives of the analyst's previous life situations transferred onto the patient» .
M. Kahn proposes to distinguish four types of countertransference feelings of the therapist: 1) realistic, conflict-free reactions of the therapist to the feelings and behavior of the patient inside and outside the session; 2) realistic reactions of the therapist to their own vicissitudes of life; 3) feelings resulting from the patient's stimulation of the therapist's unresolved conflicts; 4) feelings resulting from the patient's intense and regressive transference reactions and his primitive defenses.
The latter type also includes countertransference feelings, "invested" by the patient in the therapist in the process of projective identification. Following P. Heimann (1950), who argued that such countertransference feelings are created by the patient and are part of the patient's personality, most authors tend to see them as an instrument for exploring the patient's unconscious. At the same time, firstly, attention is drawn to the problem of recognizing this type of countertransference feelings, to the need for supervision or “internal supervision” to clarify their nature. Secondly, the issues of increasing the effectiveness of using "embedded" countertransference feelings for diagnostic and therapeutic purposes are discussed. Thirdly, especially intense countertransference feelings that arise in the process of interaction with a patient with a personality disorder are considered.
Thus, the therapist's empathy for his own feelings and his ability to "self-supervise" in the therapeutic situation allow him to distinguish and use countertransference feelings for in-depth understanding of vague feelings that are difficult to express in words and unclear, unformed experiences of the patient.
The effectiveness of using countertransference feelings for the benefit of therapy depends on a number of factors, among which are: the therapist's susceptibility to the impact exerted on him by the patient in the process of projective identification; the psychotherapist's ability to adequately handle the part of the patient's self projected onto him; the psychotherapist's ability to reconstruct the patient's messages and more.
In fact, Freud already gave decisive importance to the psychotherapist's receptivity as a factor ensuring the progress of treatment when he emphasized that no psychoanalyst will advance further than his own conflicts and internal resistances allow.
The susceptibility of the psychotherapist to the unconscious communication of the patient is manifested, from the point of view of P. Casement, in his resonance with interactive pressure. Such a reaction arises as a result of the coincidence of what relates to the personality of the psychotherapist and the material emanating from the patient. In order to become more receptive to the patient, the therapist needs to access unconscious resonances within as wide a range of feelings as possible. The therapist should strive to expand the range of empathic resonance and especially to discover the "otherness" of the other person. The more freely, according to P. Casement, the psychotherapist resonates to unfamiliar “keys”, or dissonant “harmonies”, of others, the more it will increase sensitivity to what is unconsciously transmitted by the patient in the process of projective identification.
Adequate handling of countertransference feelings implies that, on the one hand, they should not be acted out, and, on the other hand, they can be freely expressed if this contributes to progress in treatment. H. Tome and H. Kehele draw attention to that essential, in their opinion, moment when messages about feelings should be given from the point of view of complementarity, that is, from the position of observation and realistic experience, accessible to the therapist, but lacking for the patient.
The very concept of "complimentary position" was put into use by E. Deutsch (1926); J. Rucker (1957) proposed to distinguish between complementary (additional) and concordant (consistent) countertransference feelings, based on Kleinian ideas about projective and introjective identification. O. Kernberg (1989) emphasized that concordant identification helps a subtle empathic understanding of the patient, and complementary identification helps a significant Other. At the same time, O. Kernberg notes, concordant identification carries the risk of over-identification, and complementary identification - a decrease in empathy for the patient's current central experience. Such risks should be taken into account when reconstructing the interaction based on countertransference feelings.
One of the attempts to decipher metacommunicative requirements is their formulation in the language of role theory. J. Sandler (1977) states that an important part of the relationship with the object is manipulation, with the help of which the patient tries to persuade the analyst to behave in a way that is desirable for him. Sandler notes that the awareness of the imposed role makes it possible to trace the interaction to intrapsychic role relations. In essence, in terms of roles, it is discussed from whom a metacommunicative (hidden) demand is addressed to whom.
The psychotherapist's ability to adequately handle countertransference feelings and to decipher a metacommunicative (hidden) demand is well tested in interaction with a patient suffering from a personality disorder. Features of countertransference to a patient suffering from a personality disorder are discussed in the works of O. Kernberg (1989), R. Ursano et al. (1992), R. Chessik (1993), W. Meissner (1993) and other authors that attract attention to the intensity, some randomness of countertransference feelings and the need for their "utilization". It is typical for such a patient to use primitive defense mechanisms, including projective identification.
O. Kernberg believes that in the process of projective identification, a part of the Self is projected onto the psychotherapist, from which it is necessary to defend (the guilt for the “badness” of which the patient seeks to share with the therapist). The patient at the same time looks for signs of behavior in the Other, confirming that he is under the influence of the projected part. The patient unconsciously tries to provoke the therapist into the embodiment of pathological projections. Under these conditions, the therapist should be especially careful, not allowing either denial or reaction outside of the "badness" "embedded" in him.
O. Kernberg attaches decisive importance to supervision, during which it becomes possible to use countertransference feelings for a better understanding of the patient, including his metacommunicative requirements. He specifically emphasizes that the desire to avoid professional expertise, the refusal to take notes and discuss the case should be considered as signs of a pronounced countertransference. In general, Kernberg believes that countertransference feelings are "windows" into the patient's inner experience. A similar point of view is shared by most modern researchers of countertransference feelings, believing that the latter perform a "critical signaling function".
Organization and technique of psychoanalytic psychotherapy
We can formulate the goal of our efforts in different ways: awareness of the unconscious, the destruction of repressions, the filling of amnestic gaps - all this is one and the same.
Under the influence of certain historical and social circumstances, clinical psychoanalysis was divided into two closely interrelated areas - classical psychoanalysis and psychoanalytic therapy. The traditional approach focuses on helping a certain group of people with neurotic symptoms, a developed ability to reflect, to form a transference. Other patients, such as those with narcissistic disorders, were considered by Freud to be insufficiently suitable for psychoanalysis. Unlike their predecessors, modern psychoanalysts successfully work with a wide range of patients and a wide variety of situations, including psychological problems, neuroses, psychosomatic and borderline disorders, and psychoses. While maintaining the overall goal and methodology, the psychoanalytic technique can undergo more or less modification and becomes psychoanalytic psychotherapy.
Psychoanalytic therapy is understood as psychological work based on the theory and principles of psychoanalysis, but allowing the use of conditions and techniques that are different from those used in classical psychoanalysis. In a general sense, the goal of psychoanalytic therapy is to discover and reduce unconscious limitations. While in the orthodox paradigm the patient is "matched to a method" that does not involve changing existing rules, modern psychotherapy uses more flexible approaches and a variety of conditions.
Psychoanalytic therapy differs from analysis in organization, technique, and process. In the case of psychoanalytic therapy, the patient may not lie down on the couch, and the sessions may not be as frequent. The basic rule and method of free associations are not always used. Freedom of communication is encouraged to a greater extent. A trusting alliance is established between patient and therapist, and the analyst can avoid transference neurosis. The therapist in analytic therapy is more active in the choice of methods; in addition to interpretation (or instead of it), he can use methods of organizing the environment, instructions, explanations, assessment of reality, and more. Analytic therapy focuses more on the real and immediate experiences of the patient. It is usually shorter than psychoanalysis, and has as its aim not the reorganization of personality structure or character, but the removal of symptoms and the resolution of the individual's specific difficulties. Analytical therapy can vary widely - from close to the classical version to supportive. In general, analytic therapy is regarded by specialists as an important method applicable in the treatment of patients who are unable or unwilling to undergo psychoanalysis.
The generalized scheme of analytical work consists of the following points:
Establishing a therapeutic relationship that emphasizes setting– conditions, goals and rules of analytical work;
Diagnosis of the type and level of the patient's disorders, resulting in a therapeutic strategy (for example, neurotic patients are offered analysis or analytic therapy, borderline patients are recommended analytic or psychodynamic psychotherapy, psychotic patients are supportive, etc.);
Investigation of symptoms and the history of their occurrence;
Detection and processing of repetitive unconscious patterns of behavior; establishing their origin; identification of traumatic events in the patient's personal history and determination of points of fixation on specific experiences, fantasies, stages of development;
Detection of therapy resistance reactions; interpretation and study of resistance;
Activation of the patient's emotional transference reactions; detecting and interpreting transference when the patient is ready for it; clarification of the meanings of the unconscious material manifested in the transference; elaboration of transference patterns using the example of relationships with significant others in the patient's present and past; interpretation of transference as an obstacle (resistance) to therapy; transfer processing;
Periodic returns to the most significant interpretations at different stages of therapy; the achievement of an insight that reveals the connection between transference and intrapsychic conflict, which is the breeding ground for painful symptoms; transfer permission;
Identification of typical personality conflicts and individual defenses against anxiety;
Focusing on old morbidly infantile defenses and trying to discover new, more constructive and creative ways of living that have emerged in the course of therapy, etc. .
In each individual case, all or several of the listed tasks can be used. In practice, they certainly undergo various modifications.
Psychoanalytic therapy is a fairly structured process in which the following stages are distinguished: initial interview and trial meetings, the beginning of therapy; middle stage; end of therapy. In addition to this, some analysts (H. Tome, H. Kehele) consider it an important task to accompany the patient in the post-analytical period, while others (E. Tycho) insist that in order to increase self-confidence, the patient should not rely to the help of a therapist and try to subsequently cope with difficulties on their own.
For each of the identified stages of therapy, the specific features of resistance, transference and countertransference characteristic of this stage of work, as well as typical therapeutic dilemmas, are described. This trend is most clearly presented in the work of M. M. Reshetnikov "Difficulties and typical mistakes in the beginning of therapy".
Psychoanalytic therapy, like any other method of psychological assistance, has its indications and contraindications. In this regard, R. Greenson emphasizes: “ The first and most important question we must answer is: is the patient accessible to psychoanalysis? The second question depends on the circumstances: would psychoanalytic treatment be best for the patient?» .
Modern knowledge makes it possible not only to answer these questions, but also, on the basis of diagnostics, to select adequate methods of working with patients that are not suitable for traditional analysis. Changing the therapeutic strategy depends on the nature of the problem with which the patient came and the level of his functioning. Modern psychoanalysts attach great importance to psychoanalytic diagnostics in order to determine the level of the patient's impairment and the structure of his personality (character). The most accepted is the allocation of three levels of mental organization - neurotic, borderline and psychotic. This classification makes it possible to differentiate patients according to diagnostically significant criteria, which facilitates their understanding and increases work efficiency. In each of these cases, the appropriate therapeutic approach is determined.
At the same time, active attempts are being made to classify patients according to their type of character or personality structure on the basis of differences in intrapsychic conflicts, fixations and defenses. So, for example, discussing the problem of psychoanalytic diagnosis, N. McWilliams identifies such types of character organization as psychopathic, narcissistic, schizoid, paranoid, depressive - manic, masochistic, obsessive-compulsive, hysterical and dissociative. Each type is described according to the following criteria: constitution and typical affects, defensive and adaptive processes, object relations, features of transference and countertransference, criteria for differential diagnosis, and therapeutic strategies.
Stephen M. Johnson integrates conventional classification with object relations analysis, proposing the following types of character: schizoid character - the child who was hated; oral character - abandoned child; symbiotic - appropriated; narcissistic - a child who was used; masochistic - subdued child; hysterical (histrionic) - seduced; obsessive-compulsive - disciplined.
Similar to what happens in psychoanalysis, in psychoanalytic therapy conflicts that have become unconscious and conflicting tendencies must be revealed. A therapeutic relationship based on mutual trust and common goals helps the patient to continue working in the face of his own strong resistance. Thanks to the recognition of defenses and the removal of resistance, the repressed material enters consciousness in the form of unexpected ideas (insight), providing an ever greater integration of mental functioning.
Modern psychoanalytic therapy has been significantly influenced by two modern concepts - object relations theory and ego psychology, integrating them with classical views. According to R. Greenson, thanks to the emergence of a working union, the patient becomes capable of forming a special form of object relations.
Expressive psychotherapy Kernberg is one of the most striking examples of an integrated approach focused on helping a wide group of patients, including those with borderline pathology, for whom classical analysis is not suitable. The Kernberg method has a number of distinctive features, namely, a clearer formulation of the goals of therapy, a freer expression of the emotions of the patient and the therapist, an emphasis not so much on the patient's past relationships as on the therapeutic relationship between the patient and the therapist, a departure from the principle of neutrality of the therapist and his acceptance of a more active role, greater sincerity and honesty of the therapist, including the disclosure of one's own transference feelings.
The transition to the classical psychoanalytic technique in working with such patients is possible, according to Kernberg, only in the later stages of treatment, when the structure of their personality becomes predominantly neurotic. Only then can the therapist turn to an analysis of the patient's neurotic, oedipal conflicts and "there and then" interpretations of the patient's current life and past, and a firmer adherence to technical neutrality.
Insisting on the fundamental importance of interpretation as the main tool of analysis, Kernberg is of the opinion that in severe forms of self-destructiveness one needs supportive psychotherapy with the development of defense mechanisms in a "non-interpretive" way. Supportive psychotherapy allows you to improve understanding of relationships with others, form more realistic claims, increase tolerance for feelings of emptiness and boredom.
O. Kernberg emphasizes the importance of restrictions when conducting sessions with borderline patients. Restrictions on phone calls, the prohibition of reacting to aggression outside, the prohibition of frequent criticism of the psychotherapist by the patient are important conditions when conducting psychotherapy with a borderline patient. Only when the therapeutic relationship combines emotional support with clear rules can clients begin to become aware of and reintegrate previously split parts of their self. intra-individual and therapeutic relationships.
The term "working through" was introduced into psychoanalytic parlance by Freud in reference to the particular effort that succeeds in repeated attempts by the therapist to change the patient's resistance. From today's point of view, it is about analytic work with all the resistances and other factors that prevent the insights gained in the course of therapy from having an impact on structural changes. Working through in psychoanalytic therapy can be described as reconciliation work.
While Freud's psychoanalysis was a purely individual and highly standardized method of treatment, analytic psychotherapy has various forms and modifications. According to the object of analytical work, individual, group and family analytical therapy are distinguished. The last two directions are relatively new approaches, harmoniously integrating psychoanalytic theory and methods with the practice of group work.
Psychoanalytic family therapy
Any communication with people is a continuous process of learning and change.
D. Freeman
Marriage and family are the social reality in which the majority of modern people are included. On a psychological level, the family is associated with personal relationships, love and affection. These topics dominate the material of the majority of patients. Everyone who comes to the analytic office, in one way or another, experiences frustration associated with love ("love hunger") in the past or present, for themselves or others. Psychoanalytic therapy, like a spotlight, focuses on the realm of unconscious intrapsychic conflicts, reconciling the person with his own psychic reality.
The positive results of individual work often dissolve as soon as the patient returns to a dysfunctional family environment. In spite of therapeutic efforts, progress in treatment may not be observed, because the patient's family, left outside the analytic situation, unconsciously prevents any changes. On the other hand, there are cases when couples and family relationships worsen in the course of individual therapy. The psychoanalytic couch forms a trusting alliance between the patient and the psychotherapist, a kind of “psychoanalytic marriage”, and thanks to erotic transference, in some cases, a hidden love affair. Spouses left on the other side of the therapy room experience abandonment, envy, jealousy, or release from intimacy, signifying a crisis of marital intimacy.
Not surprisingly, as psychoanalysis developed as a method of providing psychological help, its obvious limitations in working with the family and other social groups were revealed. In this regard, Salvador Minukhin (1989) wrote: “ We realized that the individual taken out of the social context is a mythical monster, an illusion created by our psychodynamic ideas.» .
Family therapy emerged in the 1940s and 1950s. Dozens of people can claim to be its founders. The pioneers of family therapy were mostly psychiatrists seeking new approaches to the diagnosis and treatment of schizophrenia, depression, and other mental disorders. Many of the initiators of family therapy, such as Nathan Ackerman, Jan Alger, Murray Bowen, Lyman Wynn, Theodor Leeds, Israel Zwerling, Ivan Bozhormeniy-Negy, Carl Whitaker, Don Jackson, and Salvador Minukhin, had prior psychoanalytic training. Being passionate innovators, they abandoned the paradigm of psychodynamics and turned to the new dynamics of systems; some of them, such as Jackson and Minukhin, have departed quite far from their psychoanalytic origins, others, like Bowen, Lidz and Wynn, have retained a clear influence of psychoanalysis in their work.
Three, by that time already quite developed systems, acted as historical prerequisites for family therapy: psychoanalysis, cybernetic systems theory and group work practice. Like other social practices, family therapy has gone through a difficult path, which, with a certain degree of conventionality, can be divided into several historical stages.
1. Preparatory and research stage, rejection of the individual paradigm (beginning of the 20th century - 1940s).
2. The birth of family therapy and the creation of basic ideas (1950s).
3. The stage of "growing up" and distribution, the emergence of hundreds of family therapists (1960s).
4. "Golden Age", or the heyday of family therapy schools, the triumph of charismatic personalities (1970-1980s).
5. Time for a critical review of ideas, a return to the recognition of the importance of the role of individual changes (1990s).
6. Stage of integration of ideas and methods (present).
Over the years of its existence, the family approach has taken shape in a relatively independent scientific and practical system. Currently family therapy is a set of theories and methods based on understanding people in a family context. In psychotherapy, the family is seen as unified psychological reality, interpersonal system functioning on the principle of circular communication. If an ordinary psychotherapist works with an individual (his experiences, fantasies, past experiences), then a family therapist focuses his attention on the family as a holistic education and relationship. Family reality is described through systemic characteristics, such as family structure (composition, hierarchy, subsystems, coalitions); internal and external borders; communication style; family roles; history of marriage and family; values; myths and rituals; hidden relationship dynamics.
Depending on which family characteristic the therapist's attention is focused on, different types of family therapy: structural (focus on structure and boundaries); interactional (communication and roles); cognitive-behavioral (beliefs, skills and abilities); humanistic (meanings and values); psychoanalytic (hidden individual and group dynamics). Due to certain historical reasons in Russia, the most widespread systemic family therapy, considering the family as a living system in the aggregate of its integral characteristics (parameters of the family system).
The family approach involves the participation in therapeutic work of two or more family members. Depending on who is the object of influence, there are three main forms of psychotherapy: 1) steam room (marital); 2) child-parent; 3) actually family. Family therapy can be an independent form of psychological assistance, as well as an additional method of work that accompanies individual therapy. It can be carried out in various forms: for example, one therapist works with a couple or family at the same time; two therapists work in parallel with each of the spouses (bifocal therapy); one therapist works with several families in one session (family groups), etc.
Since about the beginning of the 1990s, family therapists have again turned to psychoanalysis. The revival of interest in psychoanalytic thinking was associated with changes attractive to family therapists, when object relations theory and ego psychology came to the forefront of the psychoanalytic movement, paying a fundamentally different attention to human relationships. The return to psychoanalysis was also facilitated by changes in family therapy itself, especially the growing dissatisfaction with the mechanistic elements of the cybernetic model. The new psychodynamic approaches found many supporters because many believed that while family therapists had uncovered deep truths about systemic relationships, they had unreasonably ignored the facts of depth psychology.
The main problem has always been the objective contradiction between psychoanalysis and the family approach: if psychoanalysis is a theory and therapy of individuals, and family therapy is a theory and therapy of social systems, is it possible to combine them? In our opinion, the entire history of psychoanalytic family therapy is an attempt to more or less successfully resolve this dilemma.
Freud was not interested in the family as an object of study. In his works, he considered the latter as the environment where people in the past acquired their neurotic conflicts. Describing family relationships (for example, in the case of the phobic little Hans), Freud was primarily interested in the analysis of the Oedipal complex of the child, but by no means family dynamics.
As a result of the absence of a family theory in Freud's metapsychology, in the early years of family therapy, the psychoanalytic approach was considered useless. Family therapy was dominated by a cybernetic view of the family as a system. Nevertheless, the activities of psychoanalytically oriented family therapists from the very beginning caused general discussion.
Tavistock (England) is considered to be the historical base of psychoanalytic family therapy. In the 1940s, Henry Dix set up a family psychiatry unit at the Tavistock Clinic, where teams of social psychiatrists tried to reconcile couples who had been sent there on divorce orders. By the early 1960s, Dix was already applying object relations theory to the study and resolution of marital conflict. Also working at Tavistock, John Bowlby considered joint family interviews an important adjunct to individual psychotherapy.
In the 1950s and 1960s, American psychoanalysis was dominated by ego psychology (which focuses on intrapsychic structures), while object relations theory (which focuses on interpersonal analysis) dominated overseas in Britain. Edith Jacobson and Harry Stack Sullivan were the most influential scientists who contributed to the transition of American psychiatry to interpersonal positions.
Nathan Ackerman founded the New York Family Institute, now named after him. His book The Psychodynamics of Family Life, published in 1958, was the first work on the diagnosis and treatment of families. Ackerman proceeded from the fact that since people live together, they should be treated together. Ackerman called his method "tickling defenses", emphasizing the importance of revealing secrets and destructive defenses.
Bozhormeniy-Negy established a family therapy center at the Eastern Pennsylvania Psychiatric Institute in 1957. Equally important to the development of family therapy were studies of schizophrenic families conducted at the National Institute of Mental Health (Irving Rickoff, Robert Cohen, Juliana Day, Lyman Wynn, and later Rodney Shapiro and John Zinner). In the 1950s and 1960s, serious works were published to describe the pathological patterns of family interaction, in which such concepts as pseudo-reciprocity, stereotyping of roles, operating with dissociations, and delineation were introduced. But perhaps the most important clinical contribution was the application of the concept of projective identification (M. Klein, W. Bion) to the family as a group.
In the 1960s, Rickoff and Wynn introduced the family dynamics course at the Washington School of Psychiatry, which led to the Family Therapy Training Program. They were joined by Shapiro, Zinner and Robert Wiener, and in 1975 Gil Savage (now Scharff) and David Scharff were also invited. By the mid-1980s, the Washington School of Psychiatry, under the direction of David Scharff, had become one of the leading centers for psychoanalytic family therapy. In 1994, the Scharffs left and founded their own institute. A characteristic feature of their work is a clear focus on object relations and a psychoanalytic approach to the family.
Currently, family therapy is actively developing, acquiring an increasingly diverse experience and its own identity. In Russia, most family therapists continue to adhere to a systematic approach; psychoanalytic family therapy has not yet become widespread. There are problems both in the professional training of psychoanalytically oriented family therapists and in the process of forming a professional community. Recently there have been promising trends. Since 2005, on the basis of the East European Institute of Psychoanalysis (St. Petersburg), a retraining cycle for doctors and psychologists in the direction of "Systemic Dynamic Family Psychotherapy" has been organized and systematically carried out, as well as an improvement cycle in psychoanalytically oriented couples therapy. The experience of training family therapists indicates an increase in the interest of specialists in this area, as well as an increasing social demand for this type of psychological assistance.
By analogy with individual analysis, within the framework of the family approach, there are psychoanalytic and psychodynamic therapy. The first is based on classical or modern psychoanalytic theory, the second on its child modifications, such as Eric Berne's transactional analysis or Adlerian family therapy.
Organizational point of view psychoanalytic family therapy is implemented in three main forms: 1) therapy of dyadic relations mother-child, based on the theories of object relations (for example, within the framework of the theory of separation-differentiation by M. Maller); 2) group family therapy based on classical theory, object relations theory and ego psychology (for example, defense tickling therapy by Nathan Ackerman); 3) marital (couple) psychoanalytic therapy based on the theory of object relations (for example, Scharff's object relations therapy).
The subject of psychoanalytic research is family unconscious, or hidden aspects of family life. In accordance with psychoanalytic ideas, the origins of marriage and family relations lie in irrational processes. Much of what we witness every day is not easy to explain: how a marriage partner is chosen, why falling in love disappears, and the idealization of a partner is inevitably replaced by its devaluation, why people end up together and why it becomes impossible for them to be together, why in some cases children in do they repeat the fate of their parents, and in others they deviate significantly from the parental model?
Unconscious processes (fantasies, defenses, conflicts) dominate conscious control. Lucky are those who manage to find a partner with identical conscious ideas and unconscious fantasies about marriage. According to Henry Dix, " we marry not a specific person, but unconscious fantasies about him» . If the ideas and expectations of the spouses do not match, then conflicts and insurmountable difficulties arise.
Psychoanalysts working with married couples focus their research in the following areas:
1) hidden individual dynamics - the level of family anxiety; transfers; dominant affects; fantasies; fears; prevailing defenses; repetitive patterns of behavior; intrapsychic conflicts; symptomatic behavior; life scenarios;
2) the history of these experiences - personal and family;
3) how the partner causes these experiences - projective identification;
4) hidden group dynamics - motivation for marriage; family history (marriage history); intergenerational inheritance of an event or problem (three-generation divorce, anniversary syndrome); "triangles"; family myths; family rituals;
5) how the setting of the therapy session and the participation of the therapist can contribute to what is happening in the family - resistance to therapy; transfer reactions; countertransference reactions; dynamics of therapy;
6) the nature of relationships in the family and therapy - the type of relationship; the degree of constructiveness - destructiveness of relations; communication style; ways of expressing love and aggression; ways to resolve conflicts; roles; cohesion; conflict areas and conflict-free zones.
Within the framework of the family approach, the issue of relationships in the norm and pathology is also considered.
The psychoanalytic model of normal family development contains concepts taken from Freud's theory, object relations theory, ego psychology. According to Freud's models, psychological well-being depends on: a) the satisfaction of instincts; b) realistic control of primitive drives; c) coordination of mental structures. According to object relations theory, the key to psychological coherence is the achievement and maintenance of mental integrity through the establishment of sufficiently good object relations.
From the point of view of the theory of object relations, marriage is a dialogue of internal(imagined) objects. The directors of marital relations are not so much the spouses themselves, but their significant others from the distant and near past. More precisely, not real people from the past, but their imaginary figures - partially unconscious images, or fantasies. The latter predetermine both the choice of a spouse and the scenario for the development of relationships.
In Essays on the Theory of Sexuality, Z. Freud wrote that the choice of an object of love is carried out according to two mechanisms: according to the support type, we choose a partner who reminds us of a loving (nursing) mother or a caring (supporting) father; in the narcissistic type, we choose a partner as ourselves or part of us - as we were, are or would like to become. Modern family therapists have made adjustments: the choice of a spouse is based not on real parents, but on their fantasy representations, according to two main principles:
1) specularity- coincidence of internal objects and unconscious fantasies;
2) complimentary– their polarity and complementarity. Examples of the mirror position of real relationships: both spouses have dependent parents; both are the only children in the family; both were rejected by the mother and have a bad inner object. Examples of complementary real relationships: he is the youngest child in the family, she is the eldest; her father is addicted to alcohol, his is emphatically distant and independent. Examples of mirroring of internal objects: both have an "evil persecuting mother"; both have an oedipal fantasy about the love of a parent of the opposite sex. Examples of complementarity of internal objects: she has a rejecting cold mother; he is caring and sacrificial.
In 1921, Z. Freud pointed out that when we fall in love, overestimation of the object of love makes us make wrong judgments based on idealization. The climax of falling in love reflects an excess of narcissistic libido, so that the object of our love becomes a substitute for our unattainable ego-ideal, with the result that our identity begins to glow in the reflected light of an idealized companion.
The influence of parental figures and relationships with them (to them) is most fully studied in psychoanalysis. At the same time, work with married couples shows that the relationship of spouses can be equally affected by other characters from their biography. For example, women entering into remarriage often look not for the optimal husband for themselves, but for a new father for their child, which becomes the main determinant of marital satisfaction and stability. Another point: if in the first marriage the main conflicts of parent-child relationships are fully played out, then remarriages are often concluded under the influence of previous marriages to win back their unresolved marital conflicts.
Recently, there has been more talk about the overlap and interdependence of unconscious fantasies and conscious representations. Some authors call it mutual projective identification others by neurotic complementarity, conjugal conspiracy, mutual adaptation, conscious and unconscious contracts.
An important cause of relationship problems in the family is the formation of distorted ideas about each other in people by attributing to one person the qualities that a significant Other had in the past (transference). Most often, we project onto family members the qualities of primary objects - mother, father, grandmother. Sibling transfer often also occurs.
At different stages of marriage, various unconscious mechanisms and defenses are activated. Thus, the choice of a marriage partner is carried out under the influence of the splitting of the image of significant figures into bad and good qualities, followed by fixation on the pluses. When falling in love, splitting and idealization are reproduced (fixation on positive qualities and their reassessment). With a long-term formation of relationships, a splitting of the partner’s image, fixation on the minuses, projective identification (the inducement of the partner to do what the previously significant Others did with you) are manifested. The mechanism of splitting an integral object into separate properties with subsequent fixation on any of them is the leading one both in positive processes of idealization, identification of spouses, and in painful conflicts and disappointments. Splitting is experienced as a conflict of ambivalence (doubt, irritation, ambivalence). As a result, it is precisely this that turns out to be guilty of both the unsuccessful choice of a partner, and the notorious “illusions” of partners, and chronic dissatisfaction with marriage, and irrational love addiction.
As a result of the listed patterns of intrapsychic dynamics in marriage, past conflicts of spouses, habitual relationships and fixed scenarios are reproduced with fatal constancy.
Based on his work with schizoid patients (1952), Ferbein developed the concept of splitting(splitting). His view of splitting is that the ego of the individual is subdivided on structures, which contain: a) part of the Ego; b) part of the object; c) relationship-related affect. An example of the simplest ego structure: mother's discontent (internal object) - feeling of one's own (part of the ego) badness - anxiety and guilt (affect).
The real (external) object (spouse, parent, child) is perceived in one of three ways: as an ideal object that gives satisfaction; as a rejecting object that causes negative affect (anger); as an exciting object that causes sexual attraction.
In a normal situation, loving parents are objects of selective and partial identification, in which only those traits are acquired that are in harmony with the image of the Self. As O. Kernberg notes, “ in fact, the main source of emotional depth and well-being is the enrichment of personal life through selective, partial identifications with people we love and admire in reality without the need to internalize their entire experience.» .
The child's unsuccessful attempt to form a whole ego and a differentiated identity causes a long and highly emotional attachment to the family (symbiotic relationship). This dependent attachment hinders a person's ability to shape their own social and family life. This, in terms of object relations, explains confusion characteristic of many symptomatic families. Generally dictated by the fear of internal objects desire to get away from real relationships is now considered the deepest cause of psychological problems in the family. It is important to understand that object relations change throughout life. Sometimes adolescence love trauma determines the style of subsequent sexual relationships. On the other hand, acting out former object relations with other people can reduce the severity of intrapsychic conflict, achieving spontaneous self-healing.
Another factor that complicates the choice of a spouse and married life is that people are trained hide your real needs and feelings. There is a sense of falsehood and deceit. Donald Winnicott called this phenomenon fake me- children behave like real angels, pretending to be who they really are not. During the courtship process, both partners are full of desire to please each other and therefore put themselves in the best light. Powerful addiction needs, narcissism, and rebellious impulses may fade into the background before marriage, but it is difficult and impossible to play someone else's role for long. Constant being with each other leads to the fact that the spouses appear in their true light, with the inevitable disappointment that follows.
Like individuals, families can move from one stage to another without fully resolving the problems of the previous period. Therefore, during one or more stages of the life cycle, heterogeneous connections (fixations) can exist in families. In times of stress, the family not only relives old conflicts, but also reverts to old models of resolving them.
An interesting interpretation of marital agreements proposed by Sager (1981): marriage as a contract. In his interpretation, each contract has three levels of awareness: 1) formulated, although not always heard; 2) conscious but not articulated, usually due to fear of anger or rejection, and 3) unconscious. Each acts as if his partner must know all the terms of the contract, and feels bitterness and anger if the other does not live up to these principles.
Family myths perform the same function in the family, simplifying and distorting reality. Myths protect family members from certain painful truths and serve to prevent unpleasant facts from being revealed. The myth of a good family is typical (everyone pretends to be in an ideal situation, carefully hiding true problems from themselves and from those around them).
In the most general way goal of psychoanalytic family therapy is the liberation of family members from unconscious restrictions that prevent them from developing and enjoying life together. Other options: detection of destructive defenses and their transformation (Ackerman); separation - differentiation (Muller); achieving safe proximity (Bowen); balance between the ability to give and receive (Bozhormeniy-Negi); neutralization and integration of aggressive and libidinal needs (Nadelson).
For more specific tasks(and at the same time stages) therapy can be attributed:
1) removal of anxiety and the resistance associated with it;
2) determination of the most conflict zones;
3) identification and development of destructive patterns of behavior of spouses;
4) release of repressed affects;
5) detection of primitive and strengthening of mature defensive reactions (especially projective identification);
6) opening and expression of suppressed needs and drives;
7) research and understanding of the spouses' unconscious fantasies and their transferences;
8) restoration of boundaries (establishment of the optimal intensity of interaction);
9) achieving more differentiated and mature forms of functioning.
The indications for therapy are: difficultly controlled marital and family conflicts; recurring negative events (for example, cheating); neurotic disorders and psychosomatic disorders in children or spouses, if they appeared in the course of family life; symptomatic behavior, such as food addictions or chemical addictions, supported by codependent behavior of family members.
Contraindications for analytical work with a family or couple are: negative attitude towards psychotherapy of one or more participants; lack of motivation to develop relationships (for example, one or both decided to leave and build a new relationship); violence in family; psychoses; deep life crisis; acute grief in connection with the loss of a loved one; chemical dependencies in the acute period.
Families experiencing a life crisis are approached with understanding and support, initially creating conditions for resolving the crisis. Once the crisis has been overcome, the psychoanalyst seeks long-term in-depth psychotherapy with the family. However, many families are more focused on short-term therapy (5-10 meetings). If family members are set to work for a short time, therapy is aimed at easing a specific symptom or actual relationship problem. The therapist should also support the family's decision to end the therapy process (so that members do not feel like failures), but warn of the possible negative consequences of prematurely ending the work.
In psychoanalytic individual therapy, it is customary to distinguish three stages: the beginning of therapy, the middle stage and the end of therapy. This division can be applied to family therapy in general. Years of experience working with families allows us to talk about the next organizational stages of family therapy.
1. Diagnostic stage(1–5 meetings):
– first contact (meeting agreement);
– initial interview, conclusion of a therapeutic contract;
- trial and diagnostic meetings.
2. Stage of therapeutic intervention(10–30 meetings):
- the beginning of therapy;
- middle stage;
- end of therapy.
3. Post-therapy support for a family or couple(by agreement):
– control and diagnostic meetings;
– post-therapeutic support;
– individual therapy of the most dysfunctional family members.
Most psychoanalytically oriented clinicians prefer to focus on the adult core of the family because it is consistent with their verbal and intellectual levels. In this regard, psychoanalytic family therapy is more often carried out with spouses, the actual conflict between which is the starting point for the study of intrapsychic and interpersonal psychodynamics.
Modern family analysts also pay significant attention to the issue of criteria and signs of "healthy families".
Regarding the family as a whole, the following mental health criteria are distinguished: 1) the functionality of the family (successful joint solution of vital tasks); 2) harmony of relations (mutual satisfaction); 3) absence of symptoms of psychosomatic, behavioral and mental disorders; 4) good social adaptation of family members; 5) constructive conflict resolution; 6) mature protection; 7) developed ability to test reality; 8) progressive development of the family.
In the literature, there is a list of psychological factors for a successful marriage:
1) psychophysiological compatibility - erotic attraction; general sensory dominant; rhythm compatibility; similarity of sensuality; complementarity of erotic fantasies;
2) cohesion and pair identity - the desire to be together; devotion; emotional acceptance of each other; identification - a sense of similarity; the feeling of "we";
3) value unity - common values, interests and preferences;
4) role consistency - complementarity of roles;
5) achieving safe proximity - the optimal psychological distance for both; the balance of separation - integration, coincidence in this; separation without the threat of decay;
6) flexibility and stress resistance;
7) synchronous development.
David Scharff gives one of the most interesting definitions of a healthy marriage: Marriage is a psychosomatic partnership» .
R. Wallerstein and colleagues conducted a specially organized study of happy married couples. The criteria for the harmony of marriage were: the stability of relations (the duration of the marriage is more than ten years); the presence of healthy children with successful social adaptation; mutual satisfaction with marriage (both spouses had to consider their marriage happy). The hypothesis that happy spouses have their own good relationship with their parents and a positive example of the parental family was not confirmed. In the studied families, with the same frequency as in the control (unhappy), there were death of parents, and violence, and divorces.
At the same time, the researchers found psychological characteristics of a happy marriage, which include:
The same value of marriage for both;
A shared fantasy that this marriage is best for them; the notion that they are best suited to each other;
desire to be together;
Concentration on the virtues of each other; attitude to marriage as a progressive work that requires attention throughout life;
Satisfactory sexual relationship;
Confidence that an affair on the side will destroy the marriage;
Confidence that marriage requires attention, effort and development.
To achieve a harmonious marriage, according to R. Wallerstein, spouses must decide a number of important tasks.
1. Emotional separation from parental families (in the second marriage - from the previous partner and the ghosts of the first marriage).
2. Achieving psychological intimacy (shared intimacy and a sense of community).
3. Creation of full and joyful sexual relations and their protection from the adverse effects of the environment (work, children, relatives, competitors).
4. Maintaining closeness at the birth of a child.
5. Ability to resist external stressors and overcome life crises.
6. Creating a safe space within the family to express disagreements and resolve conflicts.
7. The use of laughter and humor in finding out the true state of affairs, and also to avoid boredom and alienation.
8. Providing conditions of care and comfort for the partner, as well as meeting the partner's constant need for emotional and other types of support.
9. Maintaining a romantic relationship and an idealized image of each other.
The perfect marital relationship is more of a rarity than a common practice. In fact, most spouses experience temporary crises or chronic difficulties in couple relationships, which are significantly affected by problems in relationships with children and their own parents.
Family therapy is a modern method of improving the quality of family life, a kind of stumbling block in this case is the question of whether whom to invite to the first meeting and with whom the therapist should work. Unlike representatives of the systems approach, who put forward the requirement of simultaneous work with the whole family, psychoanalytically oriented family therapists prefer to combine individual and joint meetings.
There are four main methods of psychoanalytic therapy: listening, empathy, interpretation and analytical neutrality. In the case of working with a family, individual methods of work are harmoniously complemented group work techniques, such as organizing people in space, organizing dialogue, working with rules, cohesion, constructive conflict resolution techniques, and others. play a special role in working with families special methods of family therapy Keywords: genogram, family metaphors, circular interview, techniques for extinguishing family anxiety and aggression, ways to stimulate change.
Psychoanalytic therapy works through insight(understanding), but the idea that insight heals is a misleading simplification. Insights must be worked out– transformed into productive ways of behaving and responding. Most therapists work in both directions - encouraging insight and facilitating the expression of pent-up impulses.
Sessions usually begin with the therapist inviting family members to discuss the situation, feelings, and thoughts. He can start subsequent meetings either silently or by asking, “What do you want to discuss today?” He then allows the clients to speak with minimal guidance and intervention in the conversation. When the initial associations and spontaneous interactions cease, the therapist organizes a dialogue, clarifying people's thoughts, feelings, and fears. The number of interpretations is limited.
Explicit interactions of family members are considered to be disguised versions of the latent content hidden behind them. Non-analytic therapists take on the meaning of the obvious interactions of family members; analytic therapists try to uncover other material, especially that which is hidden, not conscious, or in the past. This is a very painful job that cannot take place without the constant support of a competent therapist. In this regard, Michael Nichols emphasizes the need for empathy to create a "climate of control" for the entire family.
This means that the therapist must listen and not interfere, and family members must learn to treat each other's complaints as statements of feelings and desire for change rather than attacks that threaten the integrity of their egos. The psychoanalytic therapist must overcome his desire to reassure family members, give them assessments and advice. Instead of trying to resolve the dispute, the analyst-therapist will rather intervene and ask a series of questions about the fears and desires that underlie it: why they got so angry; what do they want to say to each other; what do they expect from each other; Where do these feelings or expectations come from? Instead of focusing on who did what to whom, analytic therapists focus on strong feeling and use it as a starting point for a thorough exploration of its origins: what did you feel; When did you feel the same way before? whether it has arisen before; what do you remember?
Family therapists pay special attention to defense mechanisms and projective identification, specifically clarifying which specific actions of one cause undesirable reactions of another (what in your actions causes this reaction of a partner?).
In general, when working with families anxiety and resistance manifest more intensely than in individual therapy (at least during the first meetings). People are afraid to open up, reveal their secrets, they do not believe in improvement, they tend to criticize and blame each other. As a result, family therapy is less likely to be accepted by the family than the individual treatment of any of its members.
As part of family work, it's harder to track negative transfers(if they develop in a family format at all). The couple either attack each other or team up with each other in a fight against the therapist. Families involve specialists in the performance of missing functions such as expecting the therapist to discipline the children or provide support to the spouse. Psychological alliances and triangles quickly form. Therapists may violate neutrality by engaging in an alliance with one of the family members whose unconscious projections are most favorable for the therapist to identify with.
The described features of family therapy explain the high risk negative countertransference(of the analyst's difficult to control reciprocal feelings), which can be more intense than in individual work. Faced with high levels of anxiety and stubborn family resistance, therapists tend to feel confused and helpless, pushing them to end work prematurely. At the same time, in order to protect themselves from anxiety, family members who were previously at war with each other in a number of cases unite against the therapist, actively attacking him and devaluing his efforts. Naturally, the therapist's countertransference feelings in this case are colored by justified anger and impotent rage. In such a situation, according to Nathan Ackerman, “ the therapist must choose a middle course between the extremes of intimacy and risky outbursts of rage leading to disorganization and despair.» .
Negative feelings of patients should not be regarded as an unremovable obstacle or evidence of the ineffectiveness of therapy - they are the main, and often the only lever for the formation of motivation for positive changes. The therapist's negative experiences are also very important. When properly handled, they are a source of information about hidden family and therapy dynamics. Unlike individual therapy, family therapy encourages more open expression of the therapist's feelings. It is also recommended to work more actively with family resistance, which should be interpreted at its first manifestations.
As a result of these difficulties, family therapy is more often interrupted, has a shorter duration, and is accompanied by a greater organizing activity of the therapist. As Michael Nichols quips, " psychotherapy is expensive, time-consuming and stressful, so families try to complete it as soon as possible» .
Interpretation
The concept of interpretation presupposes that what is to be interpreted has another, additional or alternative content or meaning beyond that which appears to be manifest or obvious. In psychoanalysis, interpretation traditionally means a verbal intervention on the part of the analyst, specifically aimed at making the patient aware of the unconscious aspects of his psyche. The underlying assumption is that the patient's explicit experience has other, hidden contents and meanings in his total world of experience. conflicts, in other words, the patient has to be helped to make them conscious by overcoming the motivation and its means that prevent this.Moore and Fain (1968) defined interpretation as "the increase in the patient's knowledge by helping him to become aware of mental contents and conflicts that were previously inaccessible to awareness" (p. 58) This definition of psychoanalytic interpretation explicitly links it to the phenomena of repression and the dynamic unconscious, concepts that are familiar from psychoanalytic theory of neurotic conflict formation. taken as "officially accepted", apparently linking the interpretation to neurotic pathology, became all the more obscure the more analysts expanded their practice to include patients with more severe than neurotic disorders.
It seems that interpretation is currently one of the most obscure psychoanalytic concepts. Many analysts working with borderline and psychotic patients seem to use the term to refer to almost all reports.
analytics that deal with something in the patient that was not conscious of the patient himself. Unfortunately, this practice tends to deprive the concept of interpretation of any specific meaning, for such a wide use of the concept would justify the inclusion of such interventions as confrontation, clarification and empathic description, as well as a significant amount of purely rational information.
Along with the couch and free association, interpretation belongs to those criteria of psychoanalysis that are often taken as canonized by Freud's classic works on technology. It is widely believed that these technical tools were developed and adopted for psychoanalytic work with neurotic patients. However, to dismiss them as unsuitable when confronted with patients presenting radically different levels of experience and attachment, the analyst is often hampered by concerns about whether his work, after such a rejection of the classical technique, will still be considered true psychoanalysis. Even when the analyst actually seems to abandon classical interpretations in his work with borderline and psychotic patients, he often continues to refer to his verbal communications to the patient as interpretation. One gets the impression that often the analyst's verbal interventions, cited as interpretations in case presentations, are more in line with the empathic descriptions discussed above than with interpretations in the classical sense. Perhaps this will explain at least part of the controversy among analysts regarding the use of interpretation with patients with more severe than neurotic impairments. I will return to this subject shortly after discussing the differences between empathic descriptions and classical interpretations, and the suitability of the latter in analytic work with borderline patients.
As noted above, the classical definition of interpretation refers to helping one become aware of neurotic conflicts, thus making previously dissociated elements available for processing, and integrating them with the patient's conscious way of experiencing himself and his objects. The unconscious determinants of the patient's pathology are expected to be made available for analytic investigation through their unconscious repetition in the patient's transference, which mainly repeats the repressed oedipal fantasies and relationships in which, as a child, he had previously achieved the ability to experience himself and his objects as independent individuals. . Through interpretations and working through, the patient's transference will be resolved little by little by discarding the objects of his childhood and replacing the latter with memories relating to his childhood. This working through of the transference of the neurotic patient, including in particular his ability to give up his infantile objects, is made possible mainly by the therapeutic alliance between patient and analyst, in which the analyst presents both a current and a new evolutionary object for the patient.
The empirical situation of the borderline patient in the psychoanalytic relationship differs in many respects decisively from the psychoanalytic relationship of the neurotic patient. Unlike the latter, the borderline patient does not have integrated images of himself and the object as individuals. The patient's transference object-images are still largely functionally experienced carriers of the not yet internalized parts of his potential Self structure. His relationship with the analyst is in many ways a direct continuation of his once failed and delayed evolutionary alternatives. As a consequence of the failure to achieve individual identity, the borderline patient typically lacks the uniformity and continuity in the experience of the Self necessary for self-reflection as well as for organized recall of memories (Fraiberg, 1969) and a reliable sense of linear time. Due to the lack of individuation of the Self and object images, there is no motive and possibility of repression of unwanted images of the Self and the object, with the subsequent absence of a proper dynamic unconscious. The borderline patient shows a complete structural inability to create conflicts that are experienced as intrapsychic.
The transfer by the analyst of his phase-specifically accurate understanding to the patient is seen here as his main means of promoting renewed evolutionary processes in the latter. However, there are various obvious reasons why interpretation in the classical sense cannot correspond to the subjective experience of the borderline patient and why, accordingly, it cannot be expected to have such therapeutically favorable consequences as it seems to have in work with neurotic patients. Instead, there are many obvious reasons why empathic description, as discussed above, seems to be both a phase-specifically adequate way of conveying analytic understanding to the borderline patient and a phase-specifically correct way of activating and assisting renewed structuring in the patient.
As stated above, the usefulness of an interpretation depends on whether we "analyze" the patient's transference or not. This has to do with whether the analyst can be discarded as a transference object in the process of carefully working through insights gained through interpretations. This is more possible for the neurotic patient, whose established constancy of Self and object allows him to develop alternative relationships with individually different objects, than for the borderline patient, whose only possible initial mode of connection with the analyst is his functional transference to the latter. The missing parts of the self-structure of the borderline patient, still represented by functional objects, typically include vital impulse-regulating and self-soothing functions that still cannot be abandoned by any insight-induced processing. On a functional level, the experience of the Self is still desperately dependent on the experienced presence of the object, either in reality or as an introject. Therefore, the only way to deal with the loss of a functional object is either to replace it with another similar object, or to try to replace it with gradually ongoing processes of functionally selective identification. The functional object can be abandoned only by moving it inside the structure (Tahka, 1984).
Telling the patient that the analyst represents to him the missing parts of his own Self, accompanying his words with a possible additional "interpretation" of the genetic and historical background of such a situation, does not provide the patient with the missing structures. The intelligent borderline patient may intellectually understand such an interpretation, but it will not provide him with alternatives to his own way of experiencing himself and his objects. So if he does not take it as a direct insult or humiliation, the response of the borderline patient to such an interpretation will at best be: “OK, so what of it?”.
In the previous paragraph, I put the word "interpretation" in quotation marks, because the classic interpretations for the borderline patient are, as a rule, not real, but pseudo-interpretations. The authenticity of an interpretation, as well as of any communication from the analyst to the patient, depends on how much it is based on an analytic understanding derived from the correct integration of the analyst's emotional and rational responses to the patient and his messages. True capture of the functional and defective subjective experience of the borderline patient does not usually occur if and when the analyst perceives such an experience as reflecting a psyche suffering from unconscious conflicts in an individually conscious experiential orbit. Since this is precisely what is needed for a classical interpretation to be genuine communication that will fit the subjective experience of the patient, such interpretations given to borderline patients tend to present some degree of artificiality that leaves them mere intellectual explanations, or, when combined with some meaningful affect, as statements made at random, which may have varying degrees of non-specific impact on the patient's way of experiencing.
The traditional definition of interpretation as an utterance by the analyst aimed at making repugnant mental contents available to the patient's conscious experience implies that some previously experienced but subsequently lost representations of the Self and the object can be helped to be made consciously re-experienced. Unlike classical interpretations, empathic descriptions do not deal with the secondary loss of accessible mental structure, but rather with its primary absence. As such, they provide models for previously unrepresented experiential potentialities in the patient.
Thus, interpretations in the classical sense are understood as verbalizations of the analyst's constructs regarding dissociated areas of the patient's world of experience, while empathic descriptions include constructs of the patient's potential experience. The analyst's constructs in both cases involve his integrated understanding of what is missing from the patient's conscious and preconscious experience. However, owing to phase-specific differences in such an experience—including in particular the nature of the absent as primary absence or secondary loss—the manner and content of the analyst's communication of his understanding to the patient will differ profoundly in each case. In the first case, the analyst's transfer of his understanding of the patient's dissociated experience takes the form of an interpretation aimed at its experience by the patient as an empirical reintegration. In the second case, the analyst's communication of his understanding of the patient's somewhat defective experience will instead take the form of an empathic description, which is expected to be experienced by the patient as including a potentially new dimension to his mode of experience.
Interpretation, whether genetic or dynamic, always implies the correlation of time and history. Even when they do not include long-term genetic constructs, interpretations inherently as revealing something previously experienced but subsequently alienated are reconstructions that include a temporal aspect, while empathic descriptions refer essentially to the here-and-now experience. between patient and analyst. By presupposing the existence of actively alienated unconscious conflicts in the patient, interpretation as reconstruction presupposes the correlation of past and present, history and linear time. As shown above, such statements can only benefit the Self with an established individual identity.
It seems that only after the establishment of the constancy of the Self and the object, the time factor will be reliably useful in the structuralization of experience, and only then the construction of a significant personal history becomes phase-specifically relevant for the individual. Freud's (1914b) claim that transference repeats instead of recall becomes therapeutically useful only when an evolutionary level has been reached at which transference can in principle be abandoned and replaced by recall. This will become possible only when there are alternative relationships present at the individual level of experience and when the patient's subjective existence no longer depends on the real or introjected presence of a functional object. So long as the object, as well as the subject, cannot be experienced as independent individuals, no renunciation of the infantile object by means of mourning or comparable processes of elaboration is possible. While interpretation in the classical sense provides a phase-specific tool for initiating and assisting the above processes, it appears that at levels prior to the establishment of individual Self and object representations, the use of interpretation essentially lacks the preconditions for structure formation, as well as the operational and therapeutic rationale.
The question arises whether it is possible at all to approach, through interpretation, a psychic experience distorted by defensive actions other than repression, and if so, under what conditions. Clinical experience seems to indicate that interpretation can, in principle, be used whenever the patient has securely achieved Self-object constancy. This means that projective-introjective experiences can be interpreted as regressive phenomena to the individual Self, which resorts to primitive defensive actions as additional to the already established capacity for repression. As long as the patient is operating on a functional level, his experience is itself essentially projective-introjective, with no alternatives to such experience, and no individual Self to which interpretations can be addressed. A primitive functional experience can only be interpreted when it is present as a regressive phenomenon, not when it represents the very level that the experience has hitherto achieved. So long as this is the case, the analyst's understanding of the patient's experience can at best be conveyed to him in the form of empathic descriptions.
If interpretation is a specific tool for resolving individual transferences, empathic description is an equally specific tool for dealing with functional transfers. Interpretations having to do with the individualized patient's remaining unconscious attachments to his childhood objects as being reexternalized in his transference to the analyst ultimately tend to help the patient achieve relative subjective autonomy. Empathic descriptions, for their part, seek to help functionally delayed patients create the mental structures required to experience themselves and objects as independent individuals, including the ability to create pathologies that can be approached through interpretation. The goal of an empathic description cannot yet be autonomy, but the individuation of the patient.
The following table summarizes the main differences between empathic description and interpretation.
Comparison between empathic description and interpretation
There is a growing tendency among analysts to use interpretation in working with borderline and psychotic patients, making interpretations less "classical" through the use of here-and-now interpretation at least at the beginning of the treatment of borderline patients (Kernberg, 1976; Volkan, 1987) or by using so-called " binding interpretations" in the course of work with psychotic patients (Giovacchini, 1969). Schaefer's (1982) "affirmative" interpretations are often presented closer to empathic descriptions than to classical interpretations. The same can be said about Kohut and his school (Kohut and Wolf, 1978) regarding their habit of interpreting the negative reactions of severely disturbed patients to the analyst as the result of an empathic failure on the part of the latter. There are also some definite attempts to redefine the interpretation so that it can even include empathic descriptions as shown above. Giovaccini (1969) seems to give interpretation such a meaning when he writes: "Interpretations have to do with mental elements that were previously inaccessible to the patient" (p. 180), "The purpose of the analyst's activity is to understand and explain how the patient works. the patient's psyche, and this is an interpretive orientation-” (p. 182). According to Giovaccini, the goal of interpretation can also be the primary absence of an accessible mental structure, as well as its secondary loss. Boyer (1966) seems to have something similar in mind when he writes: "We seek not just bringing to consciousness, but achieving analytic insight" (p. 164).
In further development of this point of view, it can be argued that, in contrast to supportive treatment, the status quo is never accepted in analytic treatment, but, on the contrary, there is an ongoing effort to add something to the patient's world of experience. Thus it is possible to give psychoanalytic interpretation a very broad meaning as having to do with any clarification of the patient's empirical world, both in its general human and patient-specific aspects. Anything that the analyst communicates to the patient for this purpose, verbally or non-verbally, can be included in such a broad definition of interpretation. Another, somewhat more limited, definition would be that any transfer of information by the analyst can be called an interpretation that helps to build the patient's mental structure and promotes its integration by bringing to the patient's use previously inaccessible - either primarily missing or secondarily lost - mental contents.
However, as can be seen, attempting such a broad use of the concept of interpretation will obscure the phase-specific differences in the analyst's reports aimed at promoting structural development in patients representing different levels of pathology. Both interpretation and empathic description are verbalized messages to the patient of the analyst's understanding of the patient's predominant mode of experience. Both tend to add missing parts to the patient's present representational structures and are in this respect both developmental and transformative. Yet, in spite of these general purposes and properties, there are certain phase-specific differences in purpose, form, and results between statements that deal with repugnant mental contents and those that attempt to verbalize something that has never been experienced before.
Since the formation of unconscious conflicts, as well as relations alternative to transference, becomes possible only with the establishment of the constancy of the Self and the object, the usefulness of interpretation as a phase-specific developmental tool tends to be limited to neurotic levels of pathology, with little or no specific benefit in analytic work with borderline and psychotic patients. Thus, there appear to be some advantages in the conceptual separation of interpretation and empathic description, which appears to be a phase-specific tool for approaching patients with borderline levels of pathology.
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