Undertaking a psychoanalysis

Undertaking a psychoanalysis

Although Freud's œuvre extends to 24 volumes in the English translation, he
never wrote a textbook on psychoanalytic technique. However, between the years of
1911 and 1915, a series of short articles now referred to as the Technical Papers were
published and it is in those brief works that the essentials of psychoanalytic practice are
described. From them we learn that an analysis takes place with the patient (or
analysand, as the French school has it) lying on a couch with the analyst sitting out of
sight at the patient's head. The patient is asked to follow the fundamental rule, which is
that she say whatever comes to mind, without criticism or selection, regardless of
whether she considers it to be irrational, irrelevant, embarrassing or unpleasant. The
importance of honesty for the conduct of the analysis is emphasised. It is intended that
the patient will do most of the talking during an analysis and the analyst is advised to
say as little as possible, and only so much as is required to start and keep the patient
talking. The less the analysand knows about psychoanalysis and the psychoanalyst, the
easier it is for her to begin to find her own voice, as the therapeutic space will be less
cluttered by what she imagines the analyst thinks and expects. Such speculation is,
however, always present in an analysis as the analysand tries to guess – and incarnate -
what it is that the analyst wants.
The analyst for his part is instructed to maintain an evenly suspended attention
to what is being said to him – and simply listen. It is probably not necessary to point out
that the fundamental rule is deceptively simple. It is in fact a great deal more difficult
than it looks at first, and Freud always talked of the courage and hard work required of
anyone undergoing an analysis – but he also knew that neurosis was not to be trifled
with and was surprisingly tenacious. He never considered a cure to be easily or
speedily achieved, having learned from long experience that whilst many symptoms
can be made to disappear quite quickly, short treatments do not have long term effects.
This, then, is the outline of a psychoanalysis. The analysand lies on the couch
and talks, and the analyst listens. But what are the aims of psychoanalysis and how
does the treatment work? These questions are perhaps best approached by beginning
with a description of the conception of human nature and the human condition that
underlies psychoanalysis. All therapies have an underlying notion of what it is to be
human, although not all of them have made it explicit. The psychoanalytic view
described here (Freudian-Lacanian ) is that we are all born into the world helpless and
speechless, although not, of course, soundless. The infant is well equipped to make the
speaking beings that surround him from the beginning of his life pressingly aware of
his presence and his needs. In the first months and years, as he learns his mother
tongue, he breathes the atmosphere created by his family and caretakers and gradually
accedes (or not) to their demands, incorporating the codes of behaviour he observes
around him which are informed by the moral and aesthetic values of his family and his
society. He is thus spoken into being by those who tend him, as his demands, initially
prompted by biological need, turn into something else. This implies a particular
relationship to the attendant or primary caretaker, the mother figure. At this stage, as
Lacan puts it, 'Demand constitutes the Other as already possessing the 'privilege' of
satisfying needs, that is to say, the power of depriving them of that alone by which they
are satisfied'. This first Other is posited as being able to satisfy or reject the infant's
demands. The attachment that the infant feels for the mother is passionate and
unrestrained: he feels he is the centre of the world, and in particular, her world, and
will only give up this privileged position with a struggle.
The idea that the infant develops of this significant Other is of particular
relevance for psychoanalysis, because it is this way of construing the other, based on the
first, archaic Other of early childhood, the mOther, that a patient brings to analysis. The
patient views the analyst as someone who can operate on her in such a way as will
reduce her suffering. She assumes that the therapist can do something to her to make
her better and that the therapist has special knowledge about her, an extension of the
Freudian notion of transference. She transfers all her customary expectations and
beliefs about authority or parental figures to the person of the analyst, often mistaking
the analyst for that figure. It is a misrecognition, but it must be held in place –
deliberately maintained – for the duration of the analysis, because this relationship to
the analyst is what drives the analysis forward. A basic trust in the analyst must
develop initially in order for the fundamental rule to be applied, although there are
likely to be divergences from this attitude from time to time into a negative
transference, where the patient feels hostility and aggression towards the analyst.
Although transference is essential for an analysis, and inevitable if the analyst
maintains his analytic position, it may also be a source of resistance, as for example on
those occasions when the analysand finds it impossible to recount thoughts or fantasies
which are embarrassing, or which might cast her in a less than flattering light in front of
this person whose good opinion has come to matter a great deal. These are the
conscious resistances. There is also unconscious resistance, which can be overcome via
the analysand's dreams, for example, where the usual censor of the waking hours is
asleep and the unconscious reveals glimpses of itself.
The patient who presents for an analysis is a human subject who has been
marked by all that has happened to her up to the point of the commencement of the
analysis, but especially by the experiences of the early years when she was learning
about how to be a person and what life is. How a particular theory conceives of these
things will obviously affect the goals and method of treatment.
Psychoanalysis understands human existence as predicated on an original
traumatic loss of the first erotic attachment to the mother, and that the remainder of life
after this first loss consists in yearning and searching for this lost object of desire. The
erotic nature of this attachment to the mother is the reason for the emphasis in
psychoanalysis on sexuality. Since the original object is truly lost (and must be, since
we cannot live our lives soldered to our mothers) then all other objects of desire,
attained or not, are substitutes for it, affording varying degrees of satisfaction. Love
partners, family, friends, achievement in work and so on essentially console us for this
loss, which lies at the heart of being. Because these are all surrogates, as Freud says,
human beings can never be fully satisfied. This view of the human condition has effects
that reverberate throughout clinical practice. Most obviously, if loss is the central
structuring experience that mobilises human desire and founds the subject, a therapy
that, however indirectly, holds out the promise of wholeness or completion, is
unacceptable to psychoanalysis.
But there is more to this loss than simply the loss of the attachment to the
mother. The particular psychoanalytic view that I am describing holds that it is also
because we are speaking beings that the possibility of completion or totality is forever
lost. The argument runs as follows. Human beings are the only neurotic animals, and
that is because they are speaking beings. Language sets man apart from nature and
from that immediacy of experience that is to be found amongst other animals. Once our
lives have been 'languaged', once our reality has been plastered over and then moulded
by words, we cannot experience reality otherwise. We are incapable of divesting our
reality of language. In addition, language is simultaneously the bridge that links us to
each other and to a reality outside our bodies, but it is also the articulation that provides
a barrier to direct contact, like the articulation between railway carriages, for example.
Just as there can be no absolutely direct or unmediated experience of reality, its
representation in language is always incomplete – there is always something
inarticulable, something left out. Words are never the whole story. In the course of a
person's history, those experiences which are particularly traumatic tend to resist
effective articulation, and are therefore not assimilated at the time of occurrence. Yet
they are registered in the psyche and continue to cause pain, despite the fact that no
conscious memory of the trauma exists. These are missed encounters, and it is just this
sort of thing that psychoanalysis seeks to allow the analysand to bring closer to the
light. But it must also be noted that all matters connected with sex and death are
essentially traumatic and ultimately impossible to articulate fully. Psychoanalysis
ideally provides an environment where latent thoughts can find expression, and where
new articulations of traumatic experiences can be formulated: in this way it may be seen
as a profoundly creative process. It is also important to understand that despite the
shortcomings of language, neurotic symptoms are communications addressed to an
Other, and are signifying and decipherable. This is why the cure must be found in
language.
The analysand, who has come to the therapist with her demand – to remove the
symptoms, or to replace them, to reduce her suffering, to help her to understand why
she is the way she is, to be helped to know herself better and so on - believes
consciously that she wishes to change and that she is willing to do anything that is
required of her. But something that an analyst comes to know all too well is the
tenacity with which patients cling to their symptoms. The demand that is brought to
the therapist at the beginning, ostensibly transparent and straightforward, is
constructed in a complex way. It is never what it seems, and it takes time for it to
evolve. Ultimately, says Freud, the demands expressed at the beginning stages of an
analysis are in fact the many faces of one demand – the demand to be loved. It is this
which is in operation in the transference. In a properly handled transference, the
analyst does not respond to this demand by gratifying it, but allows the need and
longing of the patient who craves love to persist in her and drive her forward with the
analytic work. Being deprived of the analyst's gaze and facial responses forms part of
this abstinence which Freud advocates and it has the effect of foregrounding for the
analysand the non-reciprocal nature of the analytic relation. The analyst must reveal
nothing of himself, and remain cool, but it should be noted that Freud does not
advocate coldness. Although the patient knows all about her suffering, and has given
considerable time to developing theories about its causes, this has had little effect on her
condition, because she is driven by desires that are unconscious and not discernible by
introspection alone, nor are they amenable to reason. If introspection and reason could
provide the cure, then there would be no need for analysts.
Every analysis begins afresh because every human subject is different, and the
aim is to uncover the material that has been forgotten or repressed - the mnemic traces
of the traumas that the patient has experienced. Each analysis is allowed to take its own
course, because to do anything else would be to stoop to suggestion, a technique, which
Freud abjured because he said it simply did not work, and to which Lacan had
fundamental ethical objections. For Lacan the main object of analysis was to allow the
subject to speak her truth, to the extent that it is possible. Importing foreign words to
the analysand's discourse is tantamount to directing the patient, and not the treatment
(the latter of which is of course the analyst's proper business). This means that
interpretations of the analysand's utterances during the session are minimal and should
be ambiguous. The task is to allow her to hear something different in what she has said
than what she consciously intended. What it does not mean is that an analyst purports
to know what the analysand is really saying. An analyst who makes himself the
yardstick of truth is indulging in an exercise of power and setting himself up as the
arbiter of reality. The experience of analysis teaches us that the conception of a stable
and objective reality is simplistic and spurious. Heavy-handed interpretation, instead
of enlightening the patient, abolishes her as subject and maintains the analyst in the
position of the one who knows. This parental role is precisely the one that a successful
analysis should resolve.
These considerations are relevant to the place of theory in psychoanalysis.
Whilst it is true that there is a theoretical framework concerning the family constellation
and the development of the ego (an agency which is seen as largely fictive) and the
unconscious, the task of analysis is to find rather than seek. Freud tells us that the
analyst who goes looking for something will only find what he knows already. A
subject's truth cannot be known a priori – it is formed during the course of the analysis.
She does not have to be shoehorned into a particular category. The analysis should
facilitate her coming to full speech, not to mouthing the jargon of a particular theoretical
stance.
A final word about a technical matter. Some theoretical schools employ the
concept of counter-transference in their understanding of the patient. This refers to the
feelings that the analyst experiences in response to the patient. Freud never denied that
an analyst might have quite strong personal feelings towards the patient of a positive or
negative sort, but it is a mistake to situate the action of analysis at this level. The
relation of the analyst to his analysand is quite unlike any other social relation: it is
certainly not simply inter-personal, since the analyst is not there as the other of
reciprocity. To respond in this manner, making use of one's own feelings, is once again
to situate the analyst in a position of power, privileging the analyst's responses.
Resorting to the use of the counter-transference is usually the therapist's response to his
own uncertainty and anxiety, and it provides information of dubious stability and
reliability vis-à-vis the patient, although it might be a sound basis from which to
question his own subjective position.
The aim of analysis is to create a free space to allow the patient's unconscious to
speak, and the effect of an analysis that has run its term is that she is ultimately able to
shoulder the burden of her own existence herself. Freud always said that the aim of
psychoanalysis was modest enough – to change neurotic misery into ordinary human
unhappiness.

The Standard Edition of the Complete Works of Sigmund Freud (24 Vols) [1953-73] ed James Strachey
Volume 12 London:Hogarth pp.85-173

Lacan, J. Écrits: A Selection Trans. A.Sheridan London: Routledge 1977 p. 286

To avoid confusion I am using she to refer to the patient and he for the analyst.