The Talking Cure

A Descriptive Guide to Psychoanalysis

Joseph D. Lichtenberg

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781135889470
• Edition: 1
• Topic: Psychology
• Subtopic: Interpersonal Relations in Psychology
• Index: Psychology

Among the many elementary expositions of psychoanalysis, "The Talking Cure" is unique in focusing on the actual analytic experience. Lichtenberg's approach is humanistic, demonstrating empathic understanding of the fears and hopes of the person seeking help. He provides a "feel" for what happens during the analytic voyage of self-discovery.

1 Beginning the Search for Help

“People go into analysis because they are in pain,” writes Janet Malcolm. “Analysis proposes to relieve mental pain by applying more of the same.”¹ What does she mean? Let us begin with the first part of her statement: What is the pain that leads people to seek analysis? It comes in many forms.

Anxiety. For a long time Mrs. Robertson² had experienced a sense of dread. It felt as if, out of the blue, something started her heart beating fast. Her chest became tight, her mouth dry, and her swallowing difficult. If it happened during the day, she tried to reason with herself. What was she worried about? Usually she could figure out that it was something to do with her health or the safety of someone in her family. She told herself the doctor said she was all right, or that if anything had happened to the airplane her husband was on she would have heard. In any case, it was easier to hold her anxiety down during the day, when she could distract herself. At night, however, she sometimes woke up terrified, a fragment of a dream half-remembered, half-shrouded in mist. Sleep was through for the night. She tried to read, or write letters, hoping that with morning the feeling of dread would abate. But the nights got worse. And that made the days worse, too. Mrs. Robertson decided she had to find out what her anxiety was really about.

Compulsions. Mr. Daniels sometimes joked that his blood pressure was at the mercy of any fool who didn’t have a watch and kept him waiting for an appointment, or any secretary who couldn’t set a margin. A man with a great deal of charm, he enjoyed being with other people. But if there was any disruption of the roles and routines he had established for himself and those about him, Mr. Daniels became irritable, sarcastic, and totally intolerant. He did try to control his annoyance, but rarely with much success. Then, after an outburst of temper, he felt regret, suffering from bouts of guilt that were hard to shake. Trying to take himself in hand, he ended up setting even more rigid standards: “I’ll have to plan better; I’ll give my secretary more careful instructions; I’ll call to remind my wife to be on time,” etc., etc. At times he told himself that his compulsions were simply the result of his being a serious, conscientious businessman, husband, and father. But he wasn’t happy with his anger and his spells of arrogant contempt of others. One day his business partner invited him in for a heart-to-heart talk and suggested that for the good of the company he consider psychoanalysis. Mr. Daniels didn’t understand him. What he felt mostly was a compelling urgency to have “order.” It didn’t cross his mind that his demands, temper, and abrasive manner constituted an illness—one that analysis is designed to treat. What finally drove Mr. Daniels to seek help was the sight of fear in his secretary’s face and the tears in his children’s eyes. He hadn’t fully realized his effect on others before.

Disturbed relationships. Mrs. Green was beginning to feel desparate about her marriage. But she didn’t want a divorce. She had been married twice before and she couldn’t bear the thought of a third divorce. The first time, she and her husband were both too young; everyone accepted that breakup. Her second husband was unfaithful; there, too, divorce seemed the right choice. But Alex, her present husband, was a successful, mature man, and they had two children. In the first five years they had been happy. Now, however, they fought all the time, and Alex kept finding more reasons to avoid coming home. Was it something she was doing? She finally confronted Alex, and he had a plethora of complaints, as long as a laundry list. Suddenly she realized that she did too. They went to a marriage counselor, but just continued to fight in front of her. She suggested they both might benefit from individual treatment. Mrs. Green went back and forth in her mind: “Am I a nag as my mother was, or is Alex really inconsiderate? Do I become unduly hysterical over dirt on the children’s clothing, as Alex claims, or am I only a conscientious mother? Have I been withholding in my lovemaking, or is it more that I miss the attentiveness Alex showed me before the children?” Deep down she had a lot of respect for Alex—she was certain he really wanted the marriage to work. She knew he didn’t want their children to be raised in a divorced home as he and his sister had been. Besides, she had been told for years that she was neurotic and childlike. Painful as it was to look at the problem as hers, Mrs. Green was determined to do so. And with the pain, there was a feeling of hope—the idea that she could change and feel better about herself.

Boredom and general dissatisfaction. Dr. Morton, a respected professor, was embarrassed to admit to himself and to others how empty life seemed to him. He was always being told how fortunate he was. It seemed incomprehensible that despite his inheritance, his academic success, and his well-received publications, he felt blah. Once on the quest of the next distinction, he became energized, convinced that having achieved it he would finally feel fulfilled. Then, when he received it, he felt washed out and depleted, as if it were a setback. Of course with a real setback, Dr. Morton’s pride was badly bruised, but that was explicable. It was the dispiritedness he felt with his suecesses that puzzled him and convinced him that he must be “neurotic.” Also, something seemed really wrong with his relations with women. He liked them and they responded to him, but all too soon he felt bored. For a long time he rationalized his boredom as due to the women’s shallowness. Then he began to wonder if he were holding back in his feelings, or unable to feel. Certainly he felt devastated if the woman dropped him, but, to be honest, it was more his pride that was hurt than that he missed her. At the same time Dr. Morton was convinced he had more capacity to love and care than he experienced. In a strange way his pain was the lack of pain, and a sense of not tapping in on his deeper feelings or those of others. He was attracted to analysis as a treatment through which he could plumb the depths of his being and, he hoped, make contact with his feeling self.

The stories of Mrs. Robertson, Mr. Daniels, Mrs. Green, and Dr. Morton give a brief glimpse of the kinds of problems that bring people to psychoanalysis. Many more examples might be cited. Dr. Porter, for instance, was so depressed she found it difficult to get out of bed and face another day. Mr. Chambers suffered from premature ejaculation; Ms. Nelson, from frigidity. For all these people, psychoanalysis offered a chance to overcome their difficulties and gain a better understanding of themselves.

But now we come to the second part of Janet Malcolm’s statement. How can analysis propose to relieve a person’s pain by applying more of the same? On the face of it, that may sound callous. After all, a person in distress craves understanding, sympathy, and relief—not more pain. Actually the word “applying” may be deceptive here. As we shall see, it is the nature of the difficulties, the relative inaccessibility of their underlying causes, that dictates a method in which pain is reexperienced in tolerable amounts. It is never the intent of the psychoanalyst to “apply” pain. The analyst tries to understand the sources of emotional distress and mental dysfunction and, in a caring way, to use that knowledge to benefit analysands. This basic “physicianly” attitude of humanitarian caring is as ancient as human love and compassion. But what exactly makes the treatment psychoanalysis?

DISTINGUISHING PSYCHOANALYSIS

An initial way to approach the question “What is psychoanalysis?” is to inquire into the difference between psychoanalysis and other therapies. Psychoanalysis is the direct outgrowth of Josef Breuer’s treatment of Anna O. and Sigmund Freud’s extensive studies of the mind. Following Breuer’s lead, Freud believed that the common emotional troubles of otherwise well-functioning individuals—the psychoneuroses—were subject to scientific study, explanation, and treatment. By careful attention to his patients’ renditions of their thoughts and feelings, Freud concluded that the root of a psychoneurosis was embedded in the individual’s responses to life experiences—both traumatic experiences and more ordinary ones. But what was startling was that invariably these responses were related to the patients’ childhoods and to their sexual lives; these experiences were influencing them but at the same time unknown to them.

The problem Freud faced was how to get his patients to provide him with information that they had but didn’t know they had. From this information, Freud believed he and the patient would arrive at an explanation for the individual’s troubles, at an understanding that would bring relief and the possibility of change. Thus, Freud evolved the method called “psychoanalysis.” This unique approach to human suffering is not only a technique for relieving pain (a treatment); it is also a way of acquiring data about a type of illness (a research method) and a means of building ideas about the way the mind functions (a psychological theory). Our focus here, however, is on the treatment.

The mainstay of psychoanalysis is the practice of free association. Freud concluded that if people can be induced to say with honesty whatever thoughts come into their minds, the analyst will be able to decipher, from the sequence of associations, a hidden message in which the source of the neurotic symptoms is recorded. Yet for people effectively to direct their attention inward, they must be in a state of relative relaxation, at a distance from the immediate impact of day-to-day concerns. For this reason, psychoanalysis is conducted in a pleasant office setting, with the analysand lying on a couch and the analyst listening attentively, out of the analysand’s immediate view.

At this point you may have a lot of questions. Why, for instance, must the person lie on a couch? And why does psychoanalysis require analysands to come four or five times a week over a period of years? Couldn’t one come less often and sit in a chair in a conventional conversational mode? It is from precisely this reasoning that the method of helping distressed people called “psychotherapy” has evolved. What is the difference between talking face-to-face with a therapist once or twice a week and freely associating to an analyst four to five times a week?

Psychoanalysis aims to expose the nature of a person’s inner struggles. The premise is that once you become aware of what, within yourself, you are afraid of, what you may be fending off or dissociating, you will be freed to resolve conflicts and to restore an integrated sense of self. Thus, analysis deals with much more than symptoms or the immediate source of pain. Very slowly, analysis exposes aspects of personality and character in ways that promote flexibility and choice in patterns that once seemed entrenched and immovable. To accomplish this remarkable change, analysis works with the emotion-laden experience that arises out of the seemingly uncharged task of free association. The very tension that characterizes a person’s inner struggles appears in the tension that builds between analyst and analysand in the natural course of an analysis. The very disparities in the self that disturb the person arise during the analysis like a phoenix out of the ashes, and then, with the help of the analyst, become subject to understanding, yielding the potential for change and resolution. For example, during a session, an analysand may suddenly experience anxiety. There doesn’t seem to be a “reason” for this anxiety; it is “nameless.” The analyst, then, through following the pattern of associations, may be able to interpret connections to definable life experiences—to “name” the anxiety in relation to goals, urges, ambitions, shames, and guilts the analysand has.

How does this experience compare with psychotherapy? In psychotherapy people also talk about themselves and reveal their inner secrets. Here, too, the therapist attempts to recognize patterns the person isn’t aware of. By clarifying these connections and confronting people with what is revealed about the sources of their difficulties, the therapist enables them to make choices that can free them of their symptoms. What, then, is the distinction from psychoanalysis? Is the difference merely quantitative? Do people receiving psychotherapy get help, but analysands more help? Does coming once or twice a week afford some opportunity for insight and change to occur, but coming four or five times a week, a greater opportunity? I believe the answer is “yes,” but I don’t believe the quantitative dimension suffices to characterize the difference. There is a different quality to the experience that takes place in a successful psychoanalysis. The “more” of analysis is not simply more time or more continuity. What occurs in analysis is a deeper (and more painful) reexperiencing of past conflicts, combined with determined resistance to this reexperiencing, which makes for a qualitatively different tension in the analytic relationship itself. All this facilitates the potential for change to occur close to the foundation of the difficulty. Although many methods bring people relief from distress, deeply entrenched symptoms and self-defeating personality traits do not change easily. To my mind, psychoanalysis offers the best hope for their long-term amelioration.

A qualification needs to be added here, for I do not mean to dismiss psychotherapy. In referring to a therapy usually conducted one or two times a week with the person seated, I had in mind a particular method of treatment—psychoanalytically oriented psychotherapy. This treatment closely resembles psychoanalysis, in that it aims to bring about change through the exploration of unconscious patterns and it uses psychoanalytic theory in explaining the source of the individual’s emotional distress. Thus, many of my statements in subsequent chapters apply to psychoanalytic psychotherapy as well as to analysis. Moreover, at times the change-inducing tensions found in psychoanalysis arise in psychoanalytic psychotherapy as well, thereby blurring some of the lines of distinction. Why, then, might psychoanalysis be recommended for one person and psychoanalytic psychotherapy for another? Or psychoanalytic psychotherapy for the same person at one time and analysis at another? In those instances when the pattern of distress is such that an extensive change in personality seems desired and desirable, psychoanalysis is the preferred treatment. When, how-ever, the need seems more limited, more specific—such as dealing with a particular life situation—psychoanalytic psychotherapy may be the most appropriate form of help. At times neither the person in distress nor the therapist evaluating the person’s needs can be certain of the extent of the problems, so psychotherapy may be begun with the possibility of analysis later. Or psychoanalysis might be preferable but impractical—for instance, if an individual won’t be staying in the area long enough, or can’t manage the number of hours or cost. Psychoanalytic psychotherapy might then be a helpful alternative.

There are, of course, other therapies. Some are as old as civilization, including the power of suggestion as practiced by the shaman or exorcist. Others are much more modern, such as those that systematically induce pain to alter the path of pleasure in some habit such as eating or smoking. Nor is the idea that childhood influences affect adult character specific to Freud or psychoanalysis. It is a theme found frequently in literature. In 1860, for instance, Charles Dickens had Pip, the young hero of Great Expectations, say: “My sister’s bringing up had made me sensitive. In the little world in which children have their existence whosoever brings them up, there is nothing so finely perceived and so finely felt as injustice. It may be only small injustice that the child can be exposed to, but the child is small, and its world is small.”³ What Freud discovered were specific aspects of childhood centering on sexuality and aggression that have a far more profound impact than even creative geniuses like Dickens suspected. Many therapies disagree with this premise or ignore it, trying to work around it through medication, suggestion, or behavioral modification.

Certainly the plethora of therapies to choose from may be bewildering. And obviously I have a bias in choosing psychoanalysis as a focus. But I believe that in gaining a “feel” for what psychoanalysis is, you will be better able to make an informed choice.

ASKING THE FIRST QUESTION: “IS PSYCHOANALYSIS FOR ME?”

We have looked preliminarily at the question of what psychoanalysis is, but there is another, more personal question that each prospective analysand encounters: “Is psychoanalysis for me?” Mrs. Robertson, Mr. Daniels, Mrs. Green, Dr. Morton, each of them wondered: “Can I get the help I want and feel I need through a treatment designed to explore how I think and feel and act?”

In many ways it is fitting that psychoanalysis should begin with this question, for at base it is a method that brings relief and understanding through questioning—or analyzing. At first this question may be just a passing thought, easily dismissed. But with increasing pain, frustration, and doubt, it may become a central consideration, leading to serious self-assessment. Many factors play into the initial push toward psychoanalysis, and sometimes one can only identify these in retrospect. We began with a glimpse of the pain that led Mrs. Robertson, Mr. Daniels, Mrs. Green, and Dr. Morton to the question of beginning psychoanalysis. It may help at this point to describe in a more general way the different forms this question takes.

Symptom Distress as a Motivator

The direct question—”Is psychoanalysis for me?”—often arises at a point where the person is suffering from clear-cut distress. In his original case histories, Freud described a number of “neurotic” symptoms, and any of these may impel a person to undertake analysis. Repeated anxiety attacks, phobias, fits of hysteria, obsessive ruminations, compulsive rituals—these are some of the symptoms commonly associated in people’s minds with the need for psychoanalysis.

Other symptoms may take the form of a common physical disorder—the difficulty feels exactly like an ordinary body illness. A man who feels his heart beating fast may fear he is having a heart attack. A woman experiencing breathing difficulty may be afraid that something is wrong with her lungs. When a visit to a physician fails to reveal a medical problem, these people may begin to ask about psychoanalysis. Intestinal upsets, frequent colds or...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Contents
• Acknowledgments
• A Historical Note: “The Talking Cure”
• Introduction
• 1. Beginning the Search for Help
• 2. Reaching Out – Finding a Qualified Psychoanalyst
• 3. Reaching Out – Seeking the Analyst You Prefer
• 4. The Consultation
• 5. The Couch and Free Association
• 6. The Analytic “Contract”
• 7. Decisions, Decisions
• 8. Starting Out
• 9. Getting Deep into the Middle of the Analysis
• 10. Endings and New Beginnings
• Afterthoughts
• Appendix: Psychoanalytic Organizations and Training