Academic journal article International Journal of Psychoanalysis

Creating Analysts, Creating Analytic Patients1

Academic journal article International Journal of Psychoanalysis

Creating Analysts, Creating Analytic Patients1

Article excerpt

This paper applies a contemporary, 'two-track' - transformational as well as archaeological - perspective on psychoanalytic process to clinical issues in the creation of analytic patients: case finding, recommending analysis, and recommending and negotiating the intensification of frequency of sessions in analytic psychotherapy. Central importance is assigned to the role of the mind and analytic identity of the analyst, including the analyst's capacity to maintain an internal analytic frame and analyzing attitude from the very first contact with the patient and throughout the treatment, the analyst's confidence in and conviction about the usefulness of analysis for a given analytic dyad and the role of the analyst's theory, which must be broad and consistent enough to allow the analyst to feel that he or she is operating analytically when addressing non-neurotic (unrepresented and weakly represented mental states) as well as neurotic structures.

Keywords: initiating analysis, intensifying frequency, intersubjectivity, unrepresented mental states, treatment process, analyzability, case finding, transformation, countertransference, psychoanalytic psychotherapy

I. A two-track model of psychoanalysis

Case finding has become a significant problem at all levels of analytic professional development. As fewer analysts see fewer analytic patients, morale suffers, colleagues are losing confidence in the possibility, perhaps even the effectiveness, of psychoanalysis and the specificity and unique, transformative potential inherent in psychoanalysis are in danger of being replaced by a more limited vision, in which analysis is viewed as a 'super psychotherapy,' directed towards problem-solving and adaptation. These circumstances call for a re-examination of the very meaning of psychoanalysis, the scope of its application and how the analyst's assumptions and beliefs about its meaning and relevance, along with the analyst's attitudes towards and convictions about analysis, influence prospective patients and affect our ability to find and develop analytic cases. They also invite us to re-think some of the technical issues involved in recommending and initiating analysis and intensifying the frequency of analytic therapy. In this paper, the goal of this re-examination will include the elucidation of a theory that allows analysts to think and operate in ways that they feel are consistently 'psychoanalytic' in the face of patients and situations that lie outside the bounds of the more usual (neurotic) psychic functioning based on represented mental states.

When I began analytic training in the early 1970s, psychoanalysis was defined in the narrowest of terms and case finding was synonymous with the assessment of 'analyzability.' The latter was seen as an objective function of the patient's ego capacities, relatively independent of the potential of a particular analyst or dyad. At that time, initial interviews were conceptualized as exercises in medical triage, with the evaluating analyst functioning as 'gatekeeper.' The prevailing wisdom was that careful assessment of a patient's motivations, ego strengths and psychopathology would allow analysts to select appropriate patients (i.e. neurotics with more or less wellstructured psyches), who, in the hands of a 'good enough analyst,' would then go on to have successful analyses. Even allowing for recommendations of 'therapy preparatory to analysis' (e.g. Rappaport (1960) and even after the 'conversion' of patients from psychotherapy to psychoanalysis with the same analyst became an accepted practice (Bernstein, 1983; Levine, 1985), analysts, at least in the US, still tended to evaluate potential analytic cases from a perspective in which hurdles had to be cleared before analysis would be recommended.

The rationale for this set of assumptions derived in part from disappointing clinical results with patients whose psychic functioning did not readily conform to the requirements imposed by the classical model of technique. …

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