Academic journal article International Journal of Psychoanalysis

The Analyst's Anxieties in the First Interview: Barriers against Analytic Presence

Academic journal article International Journal of Psychoanalysis

The Analyst's Anxieties in the First Interview: Barriers against Analytic Presence

Article excerpt

The following reflections on the anxiety of the analyst in the first interview are directly connected to the author's participation in the Working Party of Initiating Psychoanalysis (WPIP)1 from its foundation in 2003 to the present. The ideas are generated from WPIP's systematic studies of case material from first interviews collected from the EPF Workshops on Initiat- ing Psychoanalysis. A description of preliminary results of this research is presented in the EPF Bulletin 2010 (Reith et al., 2010). In Initiating Psycho- analysis, Perspectives (Reith et al., 2011), a commented collection of papers on initiating psychoanalysis edited by the WPIP, some of the papers and some of the comments deal with resistances to initiating analysis that stem from the analyst. These ideas are further elaborated in this paper where the main focus is how to understand why analysts, irrespective of patient characteristics and the negative attitude towards psychoanalysis in general, seem to have resistances against embarking on analysis.

Why don't more people enter analysis - and how can we make more people do so?

These were the original questions the WPIP set out to answer. There are of course numerous aspects related to how psychoanalysis can be initiated, and a long list of subjects one could address. To make a simplified division one can focus on: (1) the characteristics of the patient; (2) the characteristics of the interaction between patient and analyst; (3) the characteristics of the analyst; (4) the socio-cultural context in which the meeting is taking place.

Regarding the characteristics of the patient the idea that it is possible to establish specific criteria for the potential analysand that can determine ana- lysability cannot be maintained. Levine (2007, 2010) describes the extent to which traditional effect studies within psychoanalysis (with reference to e.g. Bachrach and Leaff, 1978; Erle, 1979; Waldhorn, 1960) have demonstrated that it is not possible to isolate patient-characteristics that can predict the outcome of an analytic process - and implicit in this - that can be used initially to reach a conclusion about whether or not analysis should be rec- ommended. The development of psychoanalysis from a one-person to a two-person psychology has also changed the perception of what determines whether an analytical process is working. Kantrowitz (1993, 1995) con- cluded that the most significant criteria for a good outcome of analysis were the analytical match between analyst and analysand.

A more recent study by Caligor et al . (2009) showed both that it was not possible to identify patient characteristics that could predict whether or not a patient would be recommended psychoanalysis, and that the outcome of a consultation was connected to more subtle factors in the interaction between patient and analyst. The decision to recommend analysis, or not, was made on some basis, but not one that was captured by standard tests clarifying patient factors. It is indicated in the paper that the decision is made on more implicit qualities in each individual consultation not directly accessible to conscious conceptualization. The conclusion of this study also points to the dyadic nature of the first meeting between a potential patient and an analyst. Concerning the socio-cultural context and how it affects the possibility of getting patients the present negative attitude from the surrounding society towards psychoanalysis and the shortage of time and money are factors often used to explain the lack of patients. These are of course difficulties that must be taken into account, but they might blur the individual analyst's resistance to start analysis (Ehrlich, 2004) and the excluding attitude of institute policy (Crick, 2011, 2014).

The first meeting is a dynamic dyad

Following the mainstream shift in psychoanalysis from a one-person to a two-person psychology, the transference-countertransference matrix has increasingly become the central focus of interest also in first interviews. …

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