Some Thoughts on Interpretation and Therapeutic Action

What makes psychoanalytic work unique? What are the issues of therapeutic action that are embedded in my view of psychoanalysis ?

The key point in my view is not how psychoanalytic ways of working and in particular intervening are similar to many other psychotherapeutic treatments, but what if anything distinguishes analytic work from these other treatments.

I would suggest that interpretation alone is not the hallmark of the difference, but interpretation that attempts to facilitate the capacity to tolerate and bear psychic pain (Bion, Ruth Malcolm), particularly through language make psychoanalytic interventions unique. The analytic situation (Strachey in an unpublished lecture in 1941) is created thru the setting that then allows a very specific kind of work, on character, psychic pain and the internal world to be accomplished.

Further I would propose that such interpretations, although they may begin with a more simple structure of describing affect or commenting on a behaviour, need to develop towards an understanding of the states of mind of the patient as they are expressed through and within the transference relationship with the analyst (Joseph, Feldman, Steiner). How these alive moments in the here and now become intertwined within the unconscious phantasy of the patient’s experience of the analysis is the moment of urgency, intense affect and anxiety that permits an opening of the capacity for experiencing one’s own mind. In this manner ‘thinking’ becomes increasingly possible, self-reflection and self-observation take hold differently over time and the ability to tolerate the internal pain of despair, guilt, envy and destructive thoughts seems to increase. It is not only the analytic attitude of Schafer that creates the psychoanalytic situation. It is a necessary ingredient, but it is the interpretive work of very specific things, as ephemeral as they can sometimes be, that make for analytic change and analytic process.

There is a distinction between possible versions of what clinicians seem to mean by both the here and now as well as what is meant by change and therapeutic action.

If we revisit Strachey’s ideas about therapeutic action and what is mutative and bring it forward 50 years we move from the idea of a complete interpretation that focuses on the genetic reconstruction of the past infantile repressed memory of trauma to the construction of the past as it is alive within the transference unconscious phantasy relationship.

My suspicion is that we have both reinvented the wheel in such an idea, but also added to the understanding of what brings about change and what we mean by analytic change. This poses many problems about what we think is important to change, how much behavioural change is the more important variable and even what we mean by psychic change.

It also is a different view on how the analyst (therapist) can be a good object or a different object than the transference objects within the patient’s mind. Are we discovering new parts of old objects, being a new object or somewhat of a mix? Do we excuse ‘enactments’ as inevitable but also necessary or are they failures of our technique? Can there ever be a good self-object that replaces those that had empathic failures, and if so is this what brings about change within the analytic work itself?

I’m suggesting that many of these ideas are developed out of frustration with our technique and theory and become new techniques without understanding clearly enough what we mean by change and therapeutic action. What we may consider the goals of psychoanalytic treatment that differ from other psychotherapy treatments remains important and valuable, not in conflict with analysis, but also not the same.

In other words, I’m proposing not that something is not analysis in any pejorative way, but suggesting we need to struggle with our own thinking about what is psychoanalytic in our way of thinking and method.

To this end, the Comparative Clinical Methods research project started by David Tuckett and colleagues in Europe and further developed by me, Marie Rudden and others in North America, recognizes that it isn’t that anything can go (Tuckett’s paper of a few years ago) and should be considered psychoanalytic, but that there are many versions of psychoanalytic thinking and working with much overlap. My point is that we need to refine our thinking based both on actual practice and refining our thinking about what makes psychoanalytic treatment unique and worthwhile.

Abbot Bronstein is an IPA Training and Supervising Psychoanalyst, an Editor of the Analyst at Work section of the International Journal of Psychoanalysis and Chair for the Comparative Clinical Methods Working Party Group, North America.