Academic journal article International Journal of Psychoanalysis

Is There Still a Place for the Concept of 'Therapeutic Regression' in Psychoanalysis?

Academic journal article International Journal of Psychoanalysis

Is There Still a Place for the Concept of 'Therapeutic Regression' in Psychoanalysis?

Article excerpt

The author uses his own failure to find a place for the idea of therapeutic regression in his clinical thinking or practice as the basis for an investigation into its meaning and usefulness. He makes a distinction between three ways the term 'regression' is used in psychoanalytic discourse: as a way of evoking a primitive level of experience; as a reminder in some clinical situations of the value of non-intervention on the part of the analyst; and as a description of a phase of an analytic treatment with some patients where the analyst needs to put aside normal analytic technique in order to foster a regression in the patient. It is this third meaning, which the author terms "therapeutic regression" that this paper examines, principally by means of an extended discussion of two clinical examples of a patient making a so-called therapeutic regression, one given by Winnicott and the other by Masud Khan. The author argues that in these examples the introduction of the concept of therapeutic regression obscures rather than clarifies the clinical process. He concludes that, as a substantial clinical concept, the idea of therapeutic regression has outlived its usefulness. However he also notes that many psychoanalytic writers continue to find a use for the more generic concept of regression, and that the very engagement with the more particular idea of therapeutic regression has value in provoking questions as to what is truly therapeutic in psychoanalytic treatment.

Keywords: analytic technique, maternal metaphor, primitive experience, regression, therapeutic regression

Introduction

One of the more enduring ideas in psychoanalysis is that of some patients needing a period of regression during their treatment, and that such a regression can only be allowed by the analyst putting aside their normal analytic technique. To meet this therapeutic regression in the patient, so the argument runs, analysts must learn to give up on their normal expectation that the patient put their thoughts and feelings into words. Instead the analyst should convey to the patient that what is required is "an ordinary abandonment of reporting and thinking oneself out" (Bollas, 1987, p. 259). What counts here is not facility with interpretation, even interpretations specifically designed to appeal to the patient who is hard to reach. A different kind of attention to the regressed patient is required, one based on the qualities of "reception, musing and evocation" (Bollas, 1987, p. 273). Such an attitude invokes what Michael Balint called an object-relation based on the structure of a primary object, "an environment that accepts and consents to sustain and carry the patient like the earth or water sustains and carries a man who entrusts his weight to it" (Balint, 1968, p. 45). Winnicott preferred the model for the analyst to be that of the mother who 'holds' an infant totally dependent on her care and attention in order to survive and to flourish.

As someone who has drawn inspiration from Winnicott's work (Spurling, 2003), I have long been fascinated by these ideas on therapeutic regression. I have found them a welcome reminder of the inescapably aesthetic and intuitive aspects of the analytic attitude. However, I have also struggled to turn the concept of therapeutic regression into a meaningful idea, and been unable to find a place for it in my clinical thinking. The problem was that my patients just did not seem to regress in the ways described in the literature. To be sure, as they became engaged in their treatment they became dependent and vulnerable, sometimes intensely so, and with some patients there were times in the work when all that seemed to matter was whether or not I was able to adapt sufficiently to their needs. But such clinical situations, familiar to all practitioners, did not form themselves in my mind into a discernible phase of therapeutic regression. Nor did they seem to demand from me a different kind of analytic sensitivity over and above my attempts to embody my normal way of working. …

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