From the APA's Division 39 (Psychoanalysis), David Lichtenstein offers an overview of the current state of the field. Today's psychoanalysis bears very little resemblance to what most students learn in college psychology classes. This isn't Freud's psychoanalysis, as represented in the image above.
There has been very little research on the efficacy of psychoanalysis over its history - but that has changed during the last two or three decades. And the outcomes have been impressive - not only does psychoanalysis/psychodynamic therapy work as well as or better than more accepted models (CBT, DBT, brief therapy, and so on), but subjects generally keep improving even after the termination of therapy, something has not been shown with CBT and other well-studied models. (For research, see here and here.)
The article serves as an introduction to the current issue of the Division 39 Review.
The subject of psychoanalysis
Psychoanalysis is not only a distinct form of psychotherapeutic treatment but also a unique view of the human subject, subjectivity, and the intersubjective experience
By David Lichtenstein
Saul Bellow, the novelist, in a talk given in 1988 on his identity as an author, offered the following affirmation of his "first consciousness," a sense of his subjectivity that is continuous, certain, and sufficient in its self-identity:
The "identity problem" has vexed and plagued the modern intellect. So what business have I, in view of the "new look" for individuals (in a word, for each and every one of us) sponsored by highly influential existentialist, deconstructionist, and nihilist designers, to speak of my personality and my personal history?Bellow goes on to address the significance of this manifest identity, as experienced by him in this "first consciousness," its significance to his life as a writer, and to the cultural differences among American writers. Bellow was speaking within the context of debates in literary theory occurring at that time regarding the identity of the author, debates that drew upon psychoanalytic theory among other things, hence his reference to a "meddling mental world."
For reasons I can't explain, my own first consciousness has had a long unbroken history. I wouldn't know how to defend my faithful attachment to it. All I can say is that it is a fact and I wonder why anyone should feel it necessary to put its reality in doubt. But our meddling mental world puts all such realities in doubt. (Saul Bellow, 2011; emphasis added)
The clinical psychoanalyst, less concerned with literary criticism per se, is nevertheless alerted by this characterization of our meddlesome nature, especially the psychoanalyst thinking about what we encounter as the subject, thehuman subject, in our clinical work. Whether it is accurate to say that we put "all such realities" in doubt, it is certainly true that clinical psychoanalysts listen to speech about the presumed realities of identity with an ear to other meanings, that is, to meanings other than those of the subject's apparent first consciousness, and that for psychoanalysis the reality of identity is not to be taken as a certainty beyond question. However, neither can it be treated as a mere illusion. An unbroken history, as the conscious sense of self, is as real as the truth that there is another scene on which subjective life is also played. It is not the reality of conscious identity that is put into doubt by psychoanalysis, but rather the view that this first consciousness is a sufficient account of subjectivity.
It is an exquisite challenge in psychoanalytic practice to both respect the view expressed by Bellow about the subject's sense of an unbroken history and to allow that sense to be put in doubt by the contradictions and unexpected realizations that occur in clinical work. One can retain a "faithful attachment" to personal identity and yet discover that there are other dimensions to it than had been apparent in first consciousness, dimensions that put that apparent self in doubt. This is the paradox of the human subject as conceived by psychoanalysis: a subject rooted in and attached to personal history but also to an act of continual self-discovery and thus continual displacement of certainty regarding that history.
Psychoanalysis is often referred to as an intersubjective science, perhaps more so these days than ever before. This is generally done to highlight one or several of the following ideas: that the psychoanalytic process affects both parties, that it is not a procedure conducted on a subject by a dispassionate and detached practitioner but one that occurs between subjects, that there are two people involved and they each bring their full human subjectivity to the process, that the encounter between two subjectivities is what defines the process, and that recognizing the other as a full human subject is part and parcel of that process. In each of these, what is really meant by "the subject" is critical.
The benefits that may accrue from viewing our clinical work as intersubjective should not obscure the fact that one enduring contribution of psychoanalytic thought has been to put into question the very concept at the heart of this assertion, that is, the human subject. Psychoanalysis is built upon a new idea of the subject, and although there may be energetic debates about how best to characterize that new idea, there can be no doubt that taken together, the terms of this debate are a defining feature of the field and among the most important contributions made by psychoanalysis. Indeed, one way to view the vital debates in our field is that although we collectively recognize that we are working with a new concept of the subject, there are differences regarding what that new concept is and how to work with it.
For psychoanalysts to speak meaningfully about intersubjectivity, they first need to be clear about their view of subjectivity and of the subject in question. Certainly, the question at the heart of the theory of the subject for psychoanalysis is how to take into account the existence of the unconscious in the concept of subjectivity. Aside from the psychoanalytic view, subjectivity and consciousness are generally considered more or less the same thing: Bellow's first consciousness. With the idea that the sense of one's actions, speech, and thoughts themselves may be other than what one takes them to be, then this equation of consciousness and subjectivity no longer holds. We must instead then consider the unconscious subject, or the subject of the unconscious: the subject that speaks without a conscious reflection of itself. This is the subject "barred" from consciousness, as Lacan would say. It is a subject that speaks through slips and symptoms, dreams and unexpected ideas and associations, rather than through the unbroken awareness of self. The conscious self is always in relation to this other subjectivity, a relation characterized by more or less receptivity, more or less denial and disavowal.
Among the troubling and difficult features of the psychoanalytic subject is the status of the "I," the first person, the one who is speaking. If I speak but say things other than what I think I mean to say, then I who am speaking have been, at that moment, displaced. I am not, at that moment, the subject that I expected to be. In this sense and timing, the I is an other and speaks from another place.
How this other subjectivity may be integrated into consciousness in moments of recognition that alter the sense of "I," of first personhood, is addressed in Morris N. Eagle's recent book From Classical to Contemporary Psychoanalysis (2011) (see the review in this issue of D/R by Willliam A. MacGillivray and by Ann Erreich in Psychoanalytic Psychology [2011]). How varying "conceptions of mind," as Eagle puts it, both reflect and inform our understanding of the subject of psychoanalysis is one of the themes of this valuable book. Several contributors to this issue of DIVISION/Review address how the analyst's work is affected by the particular conception of subjectivity. Note especially Donald Moss's essay on identity and reason, Carlo Strenger's piece on the work of Robert Stolorow, Lynne Zeavin on Wilfred Bion, and Shelley Bonnano on Chris Jaenicke.
Intersubjectivity implies the interaction of two subjects, and indeed the notion is often linked to the idea of a "two-person" psychology. However, insofar as the effects of the unconscious displace the speaking subject from first consciousness, then in a sense we have to count beyond two in accounting for the subjectivities present when two people occupy a consulting room. If we accept that the subject is divided between Bellow's "first consciousness" and the other locus of unconscious function, then there are certainly four positions represented in the analytic dialogue. For the analys and, the subject of the unconscious occupies the other position, what the other position is for the analyst is another matter, because the analyst's unconscious is put into play in a different way from that of the analysand. Indeed, the technique of psychoanalysis is profoundly influenced by how we think of this interplay of subjectivities in the consulting room, what we make of the divided subject of speech, and what the analyst takes as the other position when choosing to intervene.
References
Bellow, S. (2011). A Jewish Writer in America. The New York Review of Books, Vol. LVIII, No.16, pp.26-28.
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