Academic journal article International Journal of Psychoanalysis

The First Interview: Anxieties and Research on Initiating Psychoanalysis

Academic journal article International Journal of Psychoanalysis

The First Interview: Anxieties and Research on Initiating Psychoanalysis

Article excerpt

Introduction: The analyst as a perpetual beginner

In this paper I want to discuss a constellation of issues related to initiating the psychoanalytic process in the first interviews between a patient and a psychoanalyst, research on such interviews, and the anxieties that can arise in both situations. I will define as a 'first interview' a formal consultation with an analyst, which can have a recommendation for psychoanalysis as one of the potential outcomes.

My main point will be that the inherently destabilizing effect of confrontation with the unconscious, and hence with the unknown in others as well as in oneself, can be particularly unsettling in situations where we are least prepared for it. Amongst other factors, this impact may be related to the huge amount of transformational work (Bion, 1965; Bollas, 1987; Levine, 2010; Reith, 2013) that the mind is required to do in such contexts. These phenomena are striking in the case of first interviews, where they lead to defensive reactions that can influence the psychoanalytic process, but they can even be seen in the context of research on first interviews, where they can affect the investigators and their relationship to the investigative process.

These observations are based on the findings of the Working Party on Initiating Psychoanalysis (WPIP) of the European Psychoanalytic Federation (EPF). They are the result of exchanges with analytic colleagues in workshops and panels held at EPF and IPA conferences, as well as of team work within the WPIP,1 which has been so intense that it can be difficult to figure out apres-coup who first came up with what idea. I am indebted to all these colleagues but of course I take sole responsibility for what I have done with their thoughts.2

Before describing the aims, methods and some of the findings of the WPIP, I shall give an example of the kind of case material that we have been studying and which illustrates the central theme of this paper. What follows is a condensed version of the detailed process notes that an experienced analyst brought to one of the WPIP clinical workshops.3

The interview: The handsome man on crutches

Analyst X consulted her voicemail during a holiday period and found a message from Mr B requesting an appointment: "I need psychoanalytic treatment". Because he sounded anxious, she returned his call. During their conversation, he again said: "I need treatment of some sort". As Analyst X wrote in her report to the workshop: "Sensing the urgency and the neediness behind that statement, I could readily understand the feeling I had had when I first heard his message on my voicemail. For initial interviews with a new patient, I prefer to have time to spare so that I can think about the patient and his request. Since I was at that point still on holiday, seeing him while I had so much free time ahead of me would be the kind of opportunity I do not always have. I decided to suggest an appointment a couple of days later, even though I would not normally do that, so as not to hurry things too much."

Mr B turned out to be a man in his 50s, handsome and distinguished, but looking uncomfortable and disabled, on crutches and with a splint on one leg. He explained that this was due to a traffic accident, but in such a confused way that Analyst X "found it difficult to know who had run into whom". "It's got to stop", he said. "It's ridiculous. I'm hurting myself. It's all wrong."

As she listened to him, the analyst found that there was "something youthful about him, a little naeuroive, with a boyish note to his otherwise masculine voice - as though he would agree to everything anybody asked of him but from time to time could get really angry."

He explained that he had obtained a list of names and decided to go and see whoever called back first. The broken leg was the latest in a series of incidents convincing him that he needed to talk to someone to "find out what wasn't going right for him". …

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