When people think of psychoanalytic theory as an approach to therapy, most still think of it as Freudian. While Freud is the "father" of psychoanalysis, very little of that approach is still based on techniques developed by Freud. His basic premise - that childhood issues inform most adult dysfunctions - remains as the basis of most modern depth psychology, and some of his ideas about transference remain in principle if not in practice.
Modern psychoanalytic theory has completely dismissed the privileged and "objective" stance of the therapist (which Freud advocated) in favor of relational models that recognize the importance of empathic attunement between the client and the therapist. Moreover, newer work has adopted some of (and, in fact, is partly the source of) the social constructionist ideas about the human mind - that who we are and how we function is not something that happens in a vacuum but, rather, is constructed through our interpersonal and intersubjective relationships with others.
The best known aspect of this model is attachment theory - the model of infant-caregiver interaction that helps shape all future relationships. But this same model is now a foundation in the therapeutic relationship, as well, in that the therapist can act as a surrogate attachment figure and through that relationship can help "heal" attachment failures from the client's childhood.
. This section offers a constructionist model of the mind, in line with other thinkers, such as Ken Gergen, Jermone Bruner, and others.
Minds: Uncovered or Constructed?
In my view, the traditional approach, claiming knowledge about what is going on "in the mind," as if there were something to be found there that is inert and simply discoverable, starts us off on the wrong foot. There are no clearly discernible processes corresponding to the phrase "in the patient's mind" (in contrast to neurophysiological events in the brain) for either the patient or the analyst to be right or wrong about. The kinds of mental processes, both conscious and unconscious, that analysts are most interested in are generally enormously complex and lend themselves to many interpretations. There is no uniquely correct interpretation or best guess. As with good history, there are many possible good interpretations of important events occurring in the analytic situation.
In this way of thinking, mind is understood only through a process of interpretive construction. This is equally true for the first person, who is the mind in question, and for someone in the third-person position who is trying to understand the mind of another. Further, this is true for both conscious and unconscious mental processes. In a complex interpersonal situation, one can present to another in many different ways what is or was in one's mind. In an important sense, consciousness comes into being through acts of construction either by other or, through self-reflection, by oneself. Daniel Dennett (1991), one of the most influential contemporary philosophers, proposes a "multiple drafts" model of consciousness:
Just what we are conscious of within any particular time duration is not defined independently of the probes we use to precipitate a narrative about that period. Since these narratives are under continual revision, there is no single narrative that counts as the canonical version, the 'first edition' in which are laid down, for all time, the events that happened in the stream of consciousness of the subject, all deviations from which must be corruptions of the text [p. 136].
The phrase first edition is interesting to compare with Freud's (1912) phrase "stereotype plate" p. 100. Where Freud believed, consistent with the science of his time, that there is a discernible, objective prototype that the analyst comes to be able to identify, Dennett does not, because the edition, or draft arrived at is, for Dennett, partly a product of the process through which it is produced.
In this view, mind is an enormously complex set of processes of which anyone, including the person whose mind it is, can grasp only a small, highly selective segment. Thus, there can be no singular, authoritative version "in the patient's mind" about which either the analyst or the analysand can be right or wrong. Of course, this does not mean that anything goes, that all constructions of conscious experience are equally plausible or accurate. The actual experience, despite its malleability and ambiguity, provides constraints (in a way that is similar to form level in Rorschach cards [Hoffman, personal communication]) against which interpretations are measured. But it does mean that events in the patient's mind are knowable both to the analyst and to the patient only though an active process of composing and arranging them. Many arrangements are possible; although some are better and some are worse, there are no best guesses.
Unconscious processes, by definition, are even more ambiguous. As Ogden (1994) suggests, they are experienced as absences in presences and presences in absences. To understand unconscious processes in one's own mind or that of another is not simply to expose something that has a tangible existence, as one does in lifting a rock and exposing insects beneath. To understand unconscious processes in one's own mind or that of another is to use language in a fashion that actually discovers and creates new experience, something that was not there before. And there is an additional, crucial factor in the psychoanalytic situation: through interaction with the patient, the analyst is also cocreating new conscious and unconscious experiences, including our very efforts to interpret what took place previously.
This is really the crux of the matter. Traditional claims to analytic knowledge and authority presupposed that the central dynamics relevant to the analytic process are preorganized in the patient's mind and that the analyst is in a detached and privileged position to access them. As Friedman (1996) suggests, this is not a question of humility, but of epistemology and perhaps ontology:
What carries us beyond the question of the analyst's modesty is the more radical question of whether, a hidden meaning is known even to the Eye of God. If it is, then perhaps some piece of it might also be known to the eye of the analyst. If it is not--if there is no already given predisposition from which momentary developments are lawfully elicited--then the analyst's "co-creation" of meaning is, indeed, an adventure of a vastly different sort than we have imagined [p. 260].
When it comes to the question of what is in the unconscious, determining the best interpretation, the heterogeneous state of contemporary psychoanalytic schools is probably the most persuasive evidence against a singular standard of objectivity. Each school, each theory, each clinician organizes interpretations of unconscious dynamics in a particular fashion, and there are many, many plausible interpretations, or, in Nagel's (1995) terms, many ways to enrich commonsense.
Most interesting about Friedman's position is that, although he grasps the ways in which the "co-creation of meaning" makes psychoanalysis "an adventure of a vastly different sort," he wants to retain the trappings of classical authority as a hedge against what he fears will turn out to be an abyss.
It is hard to picture how an analyst would work who no longer believes in hunting for something that is already there to be discovered. For instance, Hanly observes that the strongest pillar of analysts' authority has always been their dedication to objective truth; it is that dedication that prevents analysts from pulling rank on patients, or engaging in other personal manipulations. If there is no objective truth to be known, what self-discipline will take its place? [p. 261].
Friedman (1988) often comes to the conclusion (this is true in many places in The Anatomy of Psychotherapy) that the psychoanalytic process cannot possibly work in the way that traditional psychoanalytic theory told us it did, but that there is something valuable, indeed absolutely essential, in analysts' acting as if they still believe it works in just that way. belief in a fictional objectivity is retained as a barricade against unrestrained feeling and activity on the analyst's part. This seems a weak rationale for retaining a dubious, increasingly anachronistic doctrine. (5)
Yet it is possible to anchor self-discipline, clinical responsibility and a respect for the patient's autonomy in an acknowledgement of the intersubjective nature of the analytic enterprise rather than a denial of it. Indeed, in my experience, "rank pulling" tends to be found more often in clinical work where the analyst believes he represents objective Truth (often under the banner of "standing firm") rather than in clinical work where truth and meaning are regarded as coconstructed. The patient's autonomy is more honestly and meaningfully protected through the acknowledgment of the analyst's influence than through claims to illusory objectivity.
A fundamental difference between the traditional approach to the analyst's knowledge and authority and more contemporary approaches is that many of us believe that each analyst provides a model or theoretical framework that does not reveal what is in the patient's mind, but that makes it possible to organize the patients conscious and unconscious experience in one among many possible ways, a way that is one hopes, conducive to a richer and less self-sabotaging existence. Thus, I would make very different claims for my model of psychopathology, based on conflictual relational configurations, than Brenner makes for his model, based on conflictual childhood sexual and aggressive impulses. I do not regard my model as empirically derived and objective, although it has certainly been influenced by empirical data and would likely be changed in response to disconfirming empirical data and any growing consensus of clinicians regarding some other viewpoint. I regard my model as one among many possible and valid ways of viewing psychopathology, one that reflects both the interpretive community that I was drawn to and trained in, and also my own distinctly subjective experience. Thus, my approach to the problem of the analyst's authority and knowledge is different from the traditional one, because it presupposes a different phenomenon (a different kind of mind, ambiguous and amenable to multiple interpretations rather than prefigured and distinct) about which the analyst hopes to have authoritative knowledge.
The analyst, if he or she is meaningfully engaged in the process, inevitably becomes touched and moved by the patient, and happily so. The understandings that emerge within the analyst's mind about the patient are embedded in the fluid, interpenetrating mix of their encounter, with their perpetual impact on each other. The analyst's guesses about the patient are not simply derived from the application of his or her theory but are saturated with the analyst's countertransferential responses to the patient. The traditional notions that the analyst is essentially invisible to the patient and that the properly functioning analyst understands the patient largely in dispassionate terms are essentially illusions, serving to disclaim the analyst's personal impact.(6)
This is not at all to deny that most, if not all, patients begin by attributing vast authority of various kinds to the analyst. That initial authority, which Freud (1912) approvingly called "the unobjectionable positive transference," is not the authority that the patient will ultimately come to respect as a meaningful feature of analytic change. The latter authority is not brought to the treatment but is a product of the analyst's participation in the treatment.
One important implication of the approach I am suggesting is that any understanding of a mind, one's own or another's, is personal; it is one's own understanding, based on one's own assumptions about human life, one's own dynamics, and so on. So, unlike Freud and Brenner, I do not regard any analyst's understanding of his or her patient's mind as a best guess in any sort of objective, generic sense, but rather as that particular analyst's best guess, embedded in the analyst's experience and in the context of the predominant transference-countertransference configurations. The analyst always participates in and, inevitably, cocreates precisely what she is also collaborating with the patient to try to understand. As Donnel Stern (1997) has put it, "psychoanalysis is not a search for the hidden truth about the patient's life, but the emergence, through curiosity and the acceptance of uncertainty, of constructs that may never have been thought before" (p. 7).
The analyst's expertise lies, most fundamentally, in her understanding of a process--what happens when one begins to express and reflect on one's experience in the presence of a trained listener, in the highly structured context provided by the analytic situation.
