Wednesday, May 15, 2019

Delineating the contours of the art of psychoanalysis*

A handful of incisive passages—sundry-sized gems—gleaned from Anthony Storr’s book, The Art of Psychotherapy (Routledge, 2nd ed., 1990):
  • “Modern man tends to escape his problems by turning to drugs and drink, or by distracting himself with passive entertainment. The ease with which we can turn on the television set [or play with a smartphone], in some instances, prevent the realisation of creative capacities for solving conflict, just as it hampers children’s capacity for creative play.”
  • “No psychotherapist, and no system or theory has the ‘key’ to understanding human beings.”
  • “Today, psychotherapists are consulted by people whose symptoms are ill-defined and who are not ‘sick’ or ‘ill’ in any conventional, medical sense [he is not saying that those with symptoms of mental illness1 do not see psychotherapists, only that the class of patients, clients, or analysands is now greater than that group of individuals]. They present what [Thomas] Szasz has quite properly called ‘problems in living;’ and what they are seeking is self-knowledge, self-acceptance, and better ways of managing their lives.”
  • “Patients who have consulted doctors in the past usually expect them to take the lead, issue instructions, give advice, or ask more questions. Doctors who are not used to practising psychotherapy find it difficult to abandon their traditional authoritarian role. However, the fact that the patient, rather than the doctor, is expected to take the lead in psychotherapeutic interviews is not only the feature of such interviews which most clearly distinguishes them from conventional medical consultations, but also has many important psychological consequences.”
  • “Some patients [in psychoanalysis] are reluctant to talk because using words to define and clarify problems is unfamiliar to them [I think this fact is frequently ignored or ill-understood by intellectuals and academics]. This may be because of lack of education; a difficulty which is usually surmountable if the psychotherapist is flexible enough to adapt his use of language to the patient’s range. Other patients have been brought up in such a way that they habitually have recourse to action when faced with difficulties, and do not include ‘putting things into words’ as action. If, throughout one’s life, one has been used to dispelling anger by digging the garden, to alleviating anxiety by taking alcohol, to avoid confrontation with authority by changing one’s job, to ‘doing something’ however futile or inappropriate, it takes time to learn that clarification through words can be of use. Some such people also believe that any form of self-examination is to be deplored; that introspection is unhealthy, that talking about one’s problems is self-indulgence, a notion which, in any case, tends to disappear when the patient discovers that he has to face things about himself which he may not find easy to accept.”
  • Self-deception may involve “overestimation of our bad qualities as well as of our virtues.”
  • “… [P]sychotherapists know their patients far better than they know their own friends or colleagues, and often better than they know their own spouses or children.” Indeed, if the therapist “is at all skilled at his profession, [he] is likely to acquire more intimate knowledge of his patient than anyone else ever has or will.”
  • “The psychotherapist’s purpose is to increase the patient’s self-knowledge, both by acting as a reflecting mirror with which the patient may descry himself and also by gradually building up a coherent picture of the patient’s personality by making the interpretative connections [between events, symptoms and personality characteristics].”
  • “Although one of the main objectives of psychotherapy is to enable the patient more effectively to care for himself, and thus obviate the need for parent figures by becoming his [as it were] own parent, the emotional situation which prevails in the early stages of therapy, when a therapist is faced with a person who may be acutely distressed, is bound to be analogous to a parent-child relationship.”
  • “Psychotherapists deal predominantly, and most successfully, with people who have negative expectations; who believe that nobody wants them, or that nobody can understand them; or who are isolated because they have come to believe that intimacy with another person is a threat. If therapy goes well, the patient will come to feel that there is a least one person in the world of whom this is not true.”
  • “Healing of psychological problems is partially, if not fully, a symbolic process in which words2 and images play the major role. A great deal of the healing process is metaphorical; an ‘as if’ process in which the therapist comes to represent both a series of persons from the patient’s past, and also a series of possibilities for the future. Real improvement comes about through symbolic interaction [principally, transference and counter-transference3].”
  • “The temporary idealisation of the therapist often includes an erotic component; especially when the patient is predominantly heterosexual and the therapist is of the opposite sex [….] It is, of course, only to be expected that the patient’s feelings toward the therapist should include sexual feelings in some instances, and many patients have dreams and phantasies in which the therapist plays the part of a lover. [….] Since the patient endows the therapist with attributes which are predominantly parental … it follows that, when erotic elements coincide, the patient is trying to make the therapist into a combination of parent and lover.”
  • “While not denying that children have sexual wishes and exhibit the precursors of adult sexuality both in behaviour and in phantasy, it has long seemed to me a pity that Freud did not lay more emphasis upon the dependent component of the persistent tie with parental figures which undoubtedly afflicts the majority of neurotics.”
  • “… [P]sychotherapy today is more concerned with understanding patients as whole persons than with the abolition of particular symptoms direct.”

1. In spite of considerable skepticism regarding the term’s utility, with some going so far as to forswear its use, I think the term “mental illness”(and the professional designation, ‘psychopathology’), even if ill-understood or misused in some quarters, is an important, indeed, indispensable normative psychological concept (well illustrating ‘fact/value’ entanglement or exemplifying at once ‘thick’ descriptive and normative or evaluative properties), provided we have at least a plausible corresponding conception of mental health and well-being (in reality, we often have only an intuitive or dim notion of what makes for mental health and well-being). Of course what it means to be “ill” in this case may partially overlap with bodily or physical illness (e.g., an organic brain problem or injury found to be causally linked to such illness) such as we find it defined in contemporary biomedicine, but it is often, at best, only analogous to its meaning and purpose in modern medicine, even if we grant mind/body interaction can and frequently does play a significant part in physical illness, at least outside of disease proper. Mental illness is, loosely and in part, a scalar concept, or perhaps better, admits of degrees. Perhaps our “problems in living,” motley anxieties and neuroses, might better be thought of as instances of mental illness in a metaphorical sense (closer to the meaning of being ‘ill-at-ease’ in existential or metaphysical terms). As Richard J. McNally writes in What Is Mental Illness? (Belknap Press of Harvard University Press, 2011), “[t]he boundary between mental distress and mental illness will never be neat and clean.” There should be no stigma whatsoever attached to the concept and experience of mental illness, any more than one should be attached to physical illness. Susceptibility or vulnerability to either state or condition is part and parcel of human nature, and the refusal to name that state or condition will do nothing by way of alleviating the myriad kinds of suffering associated with such mental distress and illness.
2. On this particular use of words see, for example, Neville Symington’s A Healing Conversation: How Healing Happens (London: Karnac Books, 2006).
3. For two dictionary definitions of transference and counter-transference, see the respective entries in Jean Laplanche and Jean-Betrand Pontalis (Donald Nicholson-Smith, trans.), The Language of Psychoanalysis (London: Karnac Books, 2004; first published in 1973 by Hogarth Press), and Elizabeth Bott Spillius, et al., The New Dictionary of Kleinian Thought [Based on A Dictionary of Kleinian Thought (1991) by R.D. Hinshelwood] (London: Routledge, 2011). Finally, see too Burness E. Moore and Bernard D. Fine, eds., Psychoanalysis: The Major Concepts (Yale University Press, 1995).

* I happen to believe psychoanalysis is both an art and science of healing (in the latter sense: a unique ‘science of subjectivity’).


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