Theory of Psychoanalytic Technique

Karl A. Menninger

• Publisher: Barakaldo Books
• Year: 2020
• ISBN:
  9781839746192
• Topic: Psychologie
• Subtopic: Histoire et théorie en psychologie

This book examines the essential dynamics of the interpersonal situation involved in a two-party contract or—to use the word preferred by Dr. Maxwell Gitelson—compact. The author applies these dynamic principles to the psychoanalytic treatment situation, pointing out the pressures and values which can be mobilized to favor communication by the patient to the listening therapist and the extent to which these are followed by gratifications and frustrations which alter the balance in such a way as to determine a progressive course. If the reader will note the topics of the chapters listed he will observe that the reactions of both patient and therapist to each other in the interactive process or compact are carried systematically and successively to a point where separation of the contractees is logical. This over-all view will permit us to examine such familiar phenomena as transference, regression, resistance, interpretation, and so on in a perspective which gives them a clearer meaning. It will be objected that this sharpness or clarity involves certain distortions or misrepresentations, dependent upon oversimplification. But this is the perennial dilemma of the teacher: the teaching of facts and figures versus the teaching of truth.—Print ed.

VII—THE TERMINATION OF THE CONTRACT—The Separation of the Two Parties

WE HAVE DESCRIBED PYSCHOANALYTIC TREATMENT AS A CONTRACTUAL arrangement in the name of treatment in the course of which one party is assisted by another to effect a personality reorganization. His “ego” undergoes a functional splitting or division of duties such that one part of it (i.e., of “them” the ego functions) observes another part progressively abandon all façades of being healthy, mature, realistic, and sensible. This observed part (or set of functions) of the ego may be considered as already to some degree immature, inhibited, unrealistic, and inefficacious in its functioning—hence the patient’s need for treatment. But now, in the course of the treatment, this part changes, with many fluctuations, further and further in a retrograde direction, most notably and conspicuously during the daily fifty-minute treatment periods, often taking some of the healthy ego functions with it!

During the rest of the day the regression is kept in abeyance or under cover through dominance of the healthy ego functions. And at all times this regression, of whatever degree, remains under the scrutiny of the intact portion of the ego, a scrutiny which is supported and assisted by the psychoanalyst.

Along with the scrutiny we may assume that there goes the soft, weak voice of intelligent self-counsel. Though long ignored and resisted, it is persistent. Ultimately it is listened to and heeded.

It is a curious thing that the familiar question, “How long does treatment by psychoanalysis last?” which is heard so often inside and outside of analysis, is, at the beginning of analysis, a practical question which is apt to be given a theoretical answer whereas toward the end of analysis it becomes a theoretical question to which a practical answer is usually made. It seems incredible that after fifty years of psychoanalysis there should be such a vast difference of opinion as to what even the average length of analysis is, or should be! The three months of analysis advocated by Otto Rank proved to be a farce for some and a tragedy for others. On the other hand, we all know patients who have been in analysis for ten years or more, which seems similarly tragic or farcical. And, of course, these differences reflect differences in the goal of treatment (or mistakes in the assessment of analyzability). In the early days psychoanalysis was very much under the influence of the point of view according to which a disappearance of symptoms indicates a recession of the illness. But today we no longer regard this as an adequate criterion. The patient who has fully recovered from an illness with the aid of psychoanalysis will not have become his old self again; rather he has become (we trust) an enlarged, an improved, indeed a new self. But it is hard to say in advance how long this will take.

THE TURNING POINT

In our description of the regression (the “transference neurosis”) I discussed the general shape of the curve described by this changing level. When does the descent cease and the ascent or progression back toward “normal” begin? One may pore through the hundreds of articles on technique and on the psychoanalytic process and find few forthright discussions of this question.{172} In the long ago days of our discipline, there used to be a cardinal principle that once the painful, traumatic events of childhood were fully recalled, extracted like splinters from a child’s finger, the chronically festering wounds healed up and the patient recovered promptly, to live happily ever afterwards, we hoped.

But as we became more sophisticated—or at least more comprehensive—in our notions of etiology, we spoke less and less in these surgical terms of extracting or evacuating or recovering all painful memories. But we did not put anything in the place of that simple model. One reads very little regarding the process of recovery, of re-regression or progression or reconstitution or reconstruction. We are not even sure what best to call it. Ekstein{173} and Reider{174} inquire into precisely how it is that the observing part of the ego, the healthy part, the stable part, as we assume, becomes enlarged and strengthened by accretions from the formerly affected part. As this occurs, increasingly, the emergency makeshifts can be abandoned.

Every clinician is familiar with the symptomatic evidences of these shifts in the balance—the little day-to-day victories that mean so much to the discouraged, wistful patient. The soft but persistent voice of the intellect, plus the increasingly clearer vision of the practical benefits of better reality adaptation, the fear of pain renewed, the pull of opportunities unrealized, the fruits of better techniques of winning love—all these plus the steadily cumulative burden of the cost of treatment in time, effort, and money combine to turn the direction of the curve from downward to upward, from regression to progression. This is not to exclude the increasingly perceived effect of the example of the psychoanalyst himself—his poise, his patience, his fairness, his consistency, his rationality, his kindliness, in short—his real love for the patient.

One can speculate in various ways how to describe this turning point. The change in direction from regression to progression seems to take place through a change in conviction or belief on the part of the patient. He has presumably gotten as far from reality as possible and doesn’t like what he finds. We can’t quite say that he isn’t satisfied; it might be more accurate to say that he is satisfied that he cannot be satisfied by going further in that direction. He comes to see without equivocation that above everything else in life he wants to love and be loved, and realizes that he can give love and can get love and also that he can hate effectively when necessary. He has seen that in many respects he had never grown up, but maintained childish attitudes and longings, reaching back into his earliest infancy, which interfered with his present-day life.

Suppose we go back to the very beginning of our theoretical propositions and recollect what it was the patient came for. He came to be relieved of certain distress or certain disability; these were his symptoms. He came, as we diagrammed it, with the proposition, “I want the analyst to cure me.”

The analyst promised to assist him in getting relief from some of his distress and to set up a treatment program. Then, in the course of this treatment, wherein he was to lose these symptoms, the patient began to discover that his symptoms had a purpose, that...

Table of contents

• Title page
• TABLE OF CONTENTS
• PREFACE
• I-INTRODUCTION and HISTORICAL REVIEW
• II-THE CONTRACT-The Psychoanalytic Treatment Situation as a Two-Party Transaction
• III-THE REGRESSION-The Reaction of the Party of the First Part to the Psychoanalytic Treatment Situation.
• IV-TRANSFERENCE AND COUNTERTRANSFERENCE-The Involuntary Participation of the Second Party in the Treatment Process
• V-RESISTANCE-The Paradoxical Tendencies Exhibited by the Party of the First Part Toward Defeating the Purpose of the Contract
• VI-INTERPRETATION AND OTHER INTERVENTION-The Voluntary Participation of the Second Party
• VII-THE TERMINATION OF THE CONTRACT-The Separation of the Two Parties