Academic journal article International Journal of Psychoanalysis

Delving into the 'Emotional Storms': A Thematic Analysis of Psychoanalysts' Initial Consultation Reports 1

Academic journal article International Journal of Psychoanalysis

Delving into the 'Emotional Storms': A Thematic Analysis of Psychoanalysts' Initial Consultation Reports 1

Article excerpt

Writing about clinical work is integral to the psychoanalyst's workingthrough and understanding the analytic process. The initial meeting between an analyst and a prospective patient with the primary aim of exploring a possible treatment recommendation, otherwise known as a psychoanalytic consultation, carries a particular intensity and uncertainty that differs from usual analytic work. Therefore, the writing of consultations brings particular challenges. Consultations are intrinsically complex, subjective and pressurized due to the analyst's unfamiliarity with the prospective patient and the demand for a clear decision at its conclusion - a recommendation. The intense emotions created by the encounter itself and the fantasies of the analyst and the prospective patient create an entangled dyadic experience whereby it is often difficult for the analyst to discern: What is being transferred or projected by the prospective patient? What is evoked in the analyst? What are the needs and anxieties of the psychoanalyst, of the patient? Unlike the writing of case studies, which are based on extensive analytic work developed over time, consultation reports require the analyst to reflect on the encounter in a very short time frame. Yet, consultations are the first step to a possible psychoanalytic treatment and therefore crucial for the growth and development of the psychoanalytic profession. Consultation reports are a window into this important aspect of analytic work. It is clear that thorough exploration of how analysts experience, understand and report the consultation encounter is greatly needed.

In his paper 'Making the best of a bad job' (1979), Bion describes the initial meeting as one where an 'emotional storm' is created; a disturbance occurs formed by both the fantasies of the analyst and of the prospective patient in anticipation of the encounter and what emerges in the contact between the two. Bion (1979) describes how the analyst's recognition, observation, communication and thinking are powerfully affected by this encounter. Inevitably, the writing of consultation reports is also impacted. Ideally the consultant attempts to find a third position from which to become aware of how he is affected, observe himself in interaction with the prospective patient, and reflect on the prospective patient's experience (Baldacci and Bouchard, 2012; Racabulto, 2012; Ogden, 1992). Presumably, the writing allows for some degree of triangulation within the analyst's mind to reflect on the experience but one could also assume that, in some cases, the impact of the encounter hinders this process. What is clear is that consultation reports include a richness and complexity of experience that is not captured by standardized measures.

Apart from recent work in the EPF Working Party on Initiating Psychoanalysis discussion group (Reith et al., 2010), most studies on psychoanalytic consultations have not made use of this depth of subjective experience in consultation but rather have focused largely on easily identifiable demographic patient factors or standardized measures and have shown that these do not predict who will eventually be recommended for psychoanalysis (Caligor et al., 2009; the Psychotherapy Research Project of the Menninger Foundation, for an overview see Wallerstein, 1994). It is evident that an implicit process taking place within consultations, which might account for the analyst's decision-making process, has not been systematically investigated.

Consultation reports display not only the analysts' explicit styles of working and thinking but also implicit ones and therefore better reflect the psychic processes involved in his or her thought process than, for example, audio- or video-recorded sessions. Verbalized interpretations often do not include or convey the entirety of the analyst's thinking - consultants often put into reports more about their thinking than will have been conveyed in what they actually said to the patient. …

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