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Priory lodge LTD


Mikhail Reshetnikov
St Petersburg, March 2002

I would like to discuss the way the so-called technique of free associations can be modified and also the position the therapist holds in an analytical situation. I will try to present my approach in a brief and concise. At first glance, there will be nothing new in what I am going to say, but rather, something “superseded”.

I only want to remind my colleagues of the fact that when starting a therapy session we are usually oriented toward spontaneous speech stimulation. The goal here is obvious: we want to reveal conflicts and problems that are hidden or “blocked”.

At this stage, the analyst strictly asks questions and deftly directs y the verbal activity of the patient. In other words, his or her role is that of a careful listener. Not until some notion of the cause of the intra- or interpersonal conflict has been formed, can the processing of the material and interpretation of the unconscious begin. The goal is “to transform the unconscious into the conscious” gradually overcoming the patient’s resistance. Naturally, this is a very crude picture of what we see in practice, but, in most cases, this classical pattern is still prevalent.

The major thing here is the specific position of the interpreter – the person who is looked upon as someone who knows more, who has better, deeper understanding better whereas the patient has nothing to do but appeal to, listen to and learn from the analyst. This very stereotype is an inherent part of all psychotherapies. The patient speaks or associates; the therapist places questions, then makes a judgement or an interpretation. That is, he teaches…

In my opinion, this distribution of roles is not without its drawbacks. For the last few years I have been trying to dodge this approach by using two basic rules. The first rule is “never stimulate anything but the patient’s own material”[5] . I’ll try to explain this rule using a practical example.

Once, one of my supervisants described a session with one of his (female) patients to me. He reported word by word everything she said to him and his own response. I’ll cite only two sentences. The patient says: “I can’t have sex when my son is sick” (her son was married and lived separately from his parents). The analyst asks: “What is your husband’s attitude to that?”

According to the rule above, the analyst made a mistake, because questions like that are only allowed in ordinary conversations. But our task is not to converse with our patients, but to explore their problems. I would like to emphasize the fact that the woman had not mentioned her husband at all. So, one of the possible correct questions in that situation might be: “What is the relation between your son and your having sex?”.

I would like also to say a few words about questions we ask. Any question is always personally dependent, and partially comprises the answer or a set of the possible answers the questioner assumes. But the patient (his or her conscious and unconscious mind) can have an absolutely different “perspective of mind”. Therefore, asking an irrelevant question breaks the chain of the patient’s unpredictable associations which are so important both for the patient and for the therapeutic process. The questions must be as impersonal as possible and must contain the minimal prognostic component (in relation to the answer).

I am perfectly aware that my second rule might sound strange. In an elementary and graphic form it can be stated as follows: A good shrink is a dumb shrink. We can expand this statement by saying that within the said approach a good analyst is the one who does not give any interpretations and does not try to demonstrate his highly intellectual qualities and capabilities. Rather, he must be able (by his being silent or “chronically misunderstanding”) to stimulate the patient into making his or her own interpretations, presenting these interpretations to themselves and to the analyst, and accepting or rejecting them. In this situation the one who “knows and understands best” is not the therapist but the patient. This creates great opportunities for the personal development of the patient and for establishing a contact with his own unconscious.

I am quite aware that there might be nothing new in what has been said. All of this is a generally accepted technique. Although the above mentioned disadvantages of the classical approach are widely criticized (directly or indirectly), they are practically unavoidable.

Yet, the classical approach of interpretation does not lose its positions. Its attraction is still pretty high. The negative attitude to this approach can be traced often but only in a covert form, at the unconscious level. I will cite just a few quotations and try to show the underlying criticisms unnoticed by their authors. When treating the topic and technique of interpretations H. Tom (1996) states: “In accordance with the course of my thought I turned to one of her [the patient’s] previous dreams in which she danced and demonstrated herself in and to public… This was a hundred percent hit, and no “nos” followed… (5).

I hope you have noticed that the author was describing the course of “his thought” rather than the thoughts of his patient, although it might be absolutely different from his. Then he claims it was “a hit”, which means that “a miss” was not impossible, either.

Elsewhere, the same author wrote: “I interpreted it in a sense that in her opinion she cannot be that woman… The patient caught the thought.” (5). This eloquent construction – I thought, she thinks, I think etc. – can be left without any comment, though it is quite significant: the analyst thinks for his patient, presents his own opinion as the patient’s, and, as a result, the patient has nothing to do but “catch”, “accept” or “reject”. It’s not a secret that if the analyst is authoritative enough and if the transfer is established well enough, any patient will most likely accept whatever we give them.

Analyzing the very same topic of the role of interpretations for infantile persons, Otto Kernberg (1998) notes that “…all my attempts to construct or reconstruct resulted in a muddle or made me feel that I was taking part in a kind of sterile intellectual exercise”.

A similar approach to interpretations and indirect criticism have been expressed by Peter Cutter [6], Dinora Pines[7] and some other authors.

In my opinion, interpretations used to be vital at the first stage of the development of psychoanalysis. Today, however, psychoanalysis has become an integral part of the modern culture. Sentences like “I’m afraid you’ve been sublimating too much”, “It’s just a projection”, “She/he identifies with him too much..”, or “I wouldn’t supersede this opportunity” have spread into everyday speech, and even school boys claim to be qualified experts on the Oedipus complex. In other words, the classical technique of interpretations stirs up our patients’ irritation rather than provides an insight into his problems.

It is appropriate to mention here the fact that even Freud, who was the author and a strong proponent of the interpretation technique, noted that therapy must not “stir up the patient’s hostility”, yet specifying that “there is a danger that our influence on the patient may undermine the objective validity of our data”. He also noted that “improper [therapist’s] suggestions fall away in the course of analysis, they must be rejected and substituted by those that are more proper.” (6). In other words, Freud proposes a method of “trial and error” each of which, as we all know very well, can be fatal (to the therapy, at best).

Thus, our approach presupposes a complete denial of “trial and error method”, and is primarily intended to lower the extent of influence the analyst exerts on the patient and thereby to reduce the distortion of objective data. In other words, it is oriented toward the patient’s self-understanding and self-education rather than his or her “extra education”.

I would like to say it again: both associations and interpretations must be presented to the patient.

I am not going to illustrate this material by clinical examples because it would take to much time.

This approach does not exclude the use of interpretations as they are currently used, but rather their role and significance obviously needs critical rethinking.

[1] Bleuler (1923: 34; 1950: 67) speaks of “dereistische (or autistische) Denken”. This kind of thinking lies outside formal linear reality ; the autistic person is enclosed in his own world, he thinks in symbols, analogies, fragmentary concepts and possibly via accidental connections.
[2] We could say, in fact that he had indeed in a certain sense “run away” - he was often distracted from everyday reality. One of the characteristics of the psychotic Weltanschauung is to be often – and in chronic states all the time – distracted or split-off from a wirklich (realistic) world. According to Kant, there is a difference between wirklich (factual) reality, the essence of which we can never attain, and Wirklichkeit (perceptual, ordinary reality).
[3] Spalt
[4] psychoanalytically-oriented psychotherapist professor. Mikhail M. Reshetnikov, Ph.D. (psychology), MD is President of East-European Institute of Psychoanalysis, President of the National Federation of Psychoanalysis, a member of the Board of the PPH and NPA, currently a supervisor of NBA and the European Association of Psychotherapy.
[5] The second rule will be explained later in this paper.
[6] In particular, he noted that an interpretation is “given by the psychoanalyst in accordance with the patterns common to all people”. But we know pretty well how variable this “common “ patterns can be. By the way, in the same book Peter Cutter underlines the fact that “the processes going on in the analyst’s mind when he tries to find a correct interpretation have been hardly studied.” (p. 263-264)
[7] The author notes that we must “ be aware of what we project onto the patient”, and then adds: “No matter how strong we wish to stay in the neutral position,… we have to admit that we are not some kind of a neutral warehouse and that we constantly must be conscious of the borderline between the feelings and orientations of our patients and those of our own.”(p.33).

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