Saturday, 4 February 2017

analytic doubts

Last week I heard Phil Mollon offer his animadversive tergiversations on Kleinian / object-relations transference interpretation. To my mind he rather threw the analytic baby out with the iatrogenic bathwater. In this post I thought I'd get clear on what I think about such matters. It's hardly gonna be an argument; perhaps it's a position statement.

So here's a maddening disastrous collusive and iatrogenic practice that analysts and their patients can get caught up in. The patient brings something that's on his mind - something in a dream or an experience in a current relationship or a memory - and the analyst inexorably offers a 'transference interpretation'.  The transference interpretation shifts the attention away from the original object of the patient's concern, and points to what is allegedly going down between patient and analyst. The patient receives no help in thinking about his original problem, and is now saddled with three further problems. The first is what to think about what the analyst says. The next is what to do about the original problem which may now get lost. The third is what to do with the analyst.

Here's what I understand as the rationale for the analytic practice. Sometimes what we say really does unwittingly speak of something or someone else. Thus in the midst of chatting loosely, associatively, dreamily, with you I find myself talking about the aggravating colleague situation I met with last week. Yet, embarrassingly, it is obvious to anyone other than myself that what prompted these associations was really what I was feeling towards you. The setting of psychoanalysis - the couch, the associative mode, etc. - make this more likely still. And the value of promoting the conditions for transference and for working to understand (interpret) it is that it reveals deep preoccupations and defences of the patient which being unconscious and hence undiscerning will tend to get plastered on the analyst too, and provides an opportunity to work on and work through these in an emotionally, experientially, live way.

The problem, as I see it, comes when transference interpretations are offered not on those sporadic occasions when they're called for, but as a matter of course - i.e. inexorably. The notion that the patient is always communicating something to their analyst about their (feelings about their) analyst becomes a regulative ideal of analytic practice, a kind of axiom against which interpretations are offered. And this, to my mind, is clinically disastrous. It is in fact nothing other than an example of the kind of suggestion which analysis is supposed to be in the business of countering. It damages the patient's self-possession, distorts the power dynamic of the therapeutic relationship, encourages a spurious self-alienated stance in the patient who can all too easily now begin 'thinking' about the non-obvious matters the analyst imputes, risks adding years to analyses which now are tasked with working through iatrogenic problems merely kicked off by the dodgy analytic procedure, etc. etc.

The position Phil Mollon took seemed to be that we do well to 'minimise transference' ... along with some other suggestions - to de-emphasise the curative value of the therapeutic relationship, and position oneself as a kind of interchangeable mechanic in an external rather than internal relationship with the patient. These latter suggestions appear equally disastrous to me - given what we know of the essential value of an involved, warm, real, containing, therapeutic relationship to therapeutic progress, one in which the patient's underlying problems can surface and be worked  through. But the former seems odd too - for what could it mean? I think that what Phil must have been getting at, really, is minimising the kind of spurious and dementing and iatrogenic transference interpretations as described above. Yet this has nothing very clearly to do with minimising transference per se. Thus if the patient reacts with annoyance and frustration to the analyst who relentlessly and unhelpfully and spuriously shifts attention to the relationship in ways which do not speak to the patient, this is not a matter of negative transference but, by definition, a healthy reaction. (What however is something we might think of as a manifestation of transference is this patient's failure to tell the analyst to fuck off! To resist the spurious transference interpretation, to regain self-possession in that way, can be a valuable achievement of the analytic patient.) The only thing that true transference-minimising could mean, I think, is something like encouraging a kind of relationship to the therapist of the sort one sometimes encounters in CBT: i.e. something external, merely collaborative, focused on issues in such a way that as-yet-un-acknowledged preoccupations don't get a look-in, overlooking of the subtle and perhaps-even-not-so-subtle emotional and moral dynamics of the therapeutic interaction. And what, other than a wish to enact an avoidant attitude to authentic courageous transformational intimacy, could be the point of that?