14 May 2007

Psychotherapy as Modern Artifact

Filed under: Culture, Psychology — ktismatics @ 8:12 am

People have interpersonal desires for affection, sex, learning, communication, recognition, affiliation. These desires aim outward, seeking fulfillment in other people. People also have affordances for satisfying others’ desires. In interactions we spend a lot of time navigating the force fields of desire and affordance, moving forward slightly if there seems to be reciprocity, backing off if we sense resistance. We look for mutual attunement: by tentatively expressing our desires we seem to activate the virtual fulfillment we detect in others’ affordances, while at the same time their desires seem to detect and to elicit our affordances. Through small cycles of reciprocal desire and fulfillment we gradually we move closer together, setting aside the barriers we ordinarily maintain to protect ourselves.

In a therapeutic relationship the therapist responds positively to the client’s desire to be accepted, acknowledged, understood. The therapist is interested in the client, curious, involved, seeking to see things from the client’s perspective. The client gradually lowers his barriers, becomes more open and honest, receptive to the therapist. All this seems perfectly natural. Why, then, is it necessary to speak of transference? Why should the therapist assume that the client is recreating past relationships when he seeks to fulfill his desires through the therapist? The cues of reciprocal attunement are in play; this is a forward movement toward closer intimacy at least as much as it is a backward plunge into the past.

But the therapist is committed to the rule of abstinence, not succumbing to the client’s desire for love, or even to the therapist’s own desire reveal himself reciprocally in the evolving relationship. Faced with the therapist’s anomalous juxtaposition of receptivity and remoteness, he client becomes confused, frustrated, angry, resistant. The blocked flow of the client’s desire and his efforts to overcome the frustration becomes the main focus of analysis, revealing ways in which the client relates to the therapist in ways that repeat the client’s frustrated relationships with others in the past. In The Technique and Practice of Psychoanalysis (1967), Ralph Greenson writes:

The task is to get the reasonable ego of the patient to realize that his transference feelings are unrealistic, are based on a fantasy, and have some ulterior motive. Then the patient will be more willing to work on his feelings, to try to explore them with the aim of tracing them back to his past life.

The therapeutic relationship plays itself out simultaneously in two registers: the transference and the working alliance. Greenson again:

The working alliance is the relatively nonneurotic, rational relationship between patient and analyst which makes it possible for the patient to work purposefully in the analytic relationship… The clinical manifestations of this working alliance are the patient’s willingness to carry out the various procedures of psychoanalysis and his ability to work analytically with the regressive and painful insights which arise. The alliance is formed between the patient’s reasonable ego and the analyst’s analyzing ego. The significant occurrence is a partial and temporary identification that the patient makes with the analyst’s attitude and method of work which the patient experiences firsthand in the regular analytic sessions… The patient’s ability to form a relatively rational, desexualized, and de-aggressified relationship to the analyst stems from his capacity to have formed such neutralized relationships in his past life. The analyst contributes to the working alliance by his consistent emphasis on understanding and insight, by his continual analysis of the resistances, and by his compassionate, empathic, straightforward, and nonjudgmental attitudes… The analyst’s way of working, his therapeutic style, and the analytic setting produce an “analytic atmosphere,” which is an important means of inducing the patient to accept on trial something hitherto repelled. This atmosphere promotes the working alliance and entices the patient temporarily and partially to identify with the analyst’s analytic point of view.

You could say that the therapeutic relationship too is predicated on reciprocal transference and countertransference. The therapist projects onto the client a persona compiled from prior training and experience and professional intent; the client, also based on prior experience, responds by identifying himself with the therapist’s professional persona. Both therapist and client enter into the analytic atmosphere, a particular kind of interpersonal environment in which the client is induced to act in ways he would ordinarily find repulsive.The client plays a double role with the therapist. In the working relationship the client’s “reasonable ego” aligns himself with the therapist’s “analyzing ego,” oriented toward accomplishing the work of analysis. In the transference relationship the analyst’s analyzing ego aligns himself with the client’s neurotically regressive experiencing ego in working through the transference. For therapy to progress the client must oscillate between the working relationship and the neurotic transference, between the reasonable ego and the neurotic ego. The therapist, on the other hand, sustains the analyzing ego even during the client’s regressive, neurotic transference. Says Greenson: The relative anonymity of the analyst, his nonintrusiveness, the so-called “rule of abstinence,” and the “mirrorlike” behavior of the analyst all have the effect of preserving a relatively uncontaminated field for the budding transference neurosis. In other words, the therapist tries to present the client with a neutral but observing presence, ensuring that the transference flows exclusively from client to therapist without being triggered or shaped by the analyst’s behavior or affect. All the while, of course, the analytic atmosphere is embedded in a primal interpersonal environment continually traversed by unconscious flows of desire and affordance, continually converging and diverging in a limitless flux of virtual realities.

A third relationship exists between client and therapist: the “real” relationship. The transference relationship, while genuine, is neither realistic nor appropriate, being predicated on a repetition of the client’s prior experiences in other relationships. The working alliance is both realistic and appropriate, but it’s an artifact of the professional nature of the transaction and the analytic atmosphere established by the therapist. But there is always a real relationship that exists virtually between therapist and client, a mutual recognition that they are human beings with personalities and lives (and desires and affordances) outside (and inside) the therapy. Though the therapist attempts to present himself as a professional and a neutral transference object, his real self occasionally (always) peeks through. Similarly, the client can (will) engage the therapist not strictly as a professional or a transference object but as a real conversational partner. For the therapist to deny his “real self” to the client is to take therapeutic neutrality and abstinence into a kind of cryogenic inhumanity. Greenson again: For the analyst to work effectively and happily in the field of psychoanalysis it is important that his analytic and physicianly attitudes be derived essentially from his real relationship to the patient.

Superimposed on an interactional environment traversed by desires and affordances, the complexity of the therapeutic relationship is striking. It’s an incredibly sophisticated cultural artifact, demanding stylized and carefully nuanced choreography of both partners in the interaction. Though therapy seeks te elicit covert, regressive, irrational, chaotic, unconscious responses from the client, the relationship that facilitates these reactions is explicit, progressive, rational, disciplined, conscious. The theory is comprehensive, integrated, systematic; the praxis and the analytic atmosphere are thoroughly professsionalized, embedded in transactional exchanges of the market economy.

In short, this sort of analytic therapy is a characteristic production of high/late modernity. That isn’t an indictment; it’s merely an interpretation.



  1. ktismatics, from Lacan’s perspective, this is not so. To the contrary, the therapist aims to not react to the client’s desire to be accepted, acknowledged, understood (even as in the beginning the maintenance of this illusion – where the client sees the therapist as his ”Big Other”, or ”the subject supposed to know”, to hold the key to his desire, might be necessary). Lacan would see such an approach (attunement, nutrition) as feeding into the client’s Imaginary. Lacan wants to translate the Imaginary into the Symbolic, images into words, precisely to shatter this illusion afforeded by identification (with the Big Other), that there is some external guarantee of acceptance.

    Why should the therapist assume that the client is recreating past relationships when he seeks to fulfill his desires through the therapist?

    Because Lacan’s model of personality is like the Moebius strip, (we discussed this topography before), it is not that old relationships are ”behind” the transferrential relationship, being ”recreated”; rather, these old relationships ARE the transferrential relationship – it’s just that the neurotic client does not see them as such, displaces them in the Imaginary, the signifiers keep ”sliding away from the point” and the attachment between the signifier and the signified (of these past experiences) is not fixed, or you could say properly located. Ergo, successful analysis would allow the old relationships to finally be relegated to the past.

    I mentioned this already in the context of dream interpretation. Lacan is not interested in the content of dreams, but in the language of their recounting in analysis, because he knows that the unconscious speaks in the present, in the now.


    Comment by parodycenter — 14 May 2007 @ 9:35 pm

  2. Ktismatic all this is very well described in Bruce Fink’s book LACANIAN PSYCHOANALYSIS THEORY AND TECHNIQUE by Bruce Fink, chapter Engaging the Patient


    Comment by parodycenter — 14 May 2007 @ 9:50 pm

  3. parody –

    Thanks. The Lacanian terminology remains so strange and elusive to me. the therapist aims to not react to the client’s desire to be accepted, acknowledged, understood … I think there’s no need to invoke transference, fantasy, etc. — doesn’t everyone want to be accepted, acknowledged and understood? Isn’t that a realistic expectation that we approach to a greater or lesser degree in most relationships? So the Lacanian specifically and consciously refuses to gratify this sort of ordinary expectation why? Because most people overemphasize the importance of this sort of acceptance from the other, regard it as crucial to satisfying their desire, never can get enough of it? So that this desire eventually is renounced? It seems counterintuitive. It also seems like the therapeutic relationship takes on a kind of ascetically sado-masochistic tenor. Not so?

    So the impact of old relationships has gotten abstracted away from the actual relationships, turned into some sort of disembodied desire and behavior pattern? And analysis tries to re-embody them, reconnecting them to the original sources, so that new relationships can enact new desires and behaviors and fulfillments?

    I’ve seen Fink’s book referenced before, I think on Synthome’s website. Lacan is a very elusive fellow, as I’m sure you’ve heard from others. The most intriguing thing to me about him is his analytic strangeness relative to ordinary relationships, not just recognizing but maximizing the intrinsic deviance of the analytic setup.


    Comment by ktismatics — 14 May 2007 @ 10:15 pm

  4. from Fink:

    the subject supposed to know in psychoanalysis is the subject’s unconscious. The ”final authority” in the analytic setting thus resides in the analysand’s unconscious, not in the analyst as some sort of a master of knowledge who immediately grasps the meaning of symptoms. Yet the analysand tends to view the analyst as the representative or agent of every such manifestation. He refuses responsibility for such manifestations. It might therefore be said that it is not the analysand’s unconscious that is the ultimate authority, but rather the unconscious as manifested VIA the analysand. For such manifestations are disowned by the analysand as foreign or other, as not his or hers.


    Comment by parodycenter — 14 May 2007 @ 10:59 pm

  5. The analyst may encourage or discourage this. Insofar as the analyst is unwilling to keep his or her own personality out of the analytic relationship (ie resist being a placeholder for or representative of the analysand’s unconscious), he or she reinforces the assumption made by most new analysands that the analyst is a person more or less like themselves. In the course of the preliminary meetings the analyst must allow a shift to occur in the analysand’s mind from being an other person to being a person ”under erasure” (sous rature). In other words, the person of the analyst must disappear if he or she is to stand in for the unconscious. He must become a more abstract other, the other that speaks inadvertently, in the slips and craks in the analysand’s discourse. He or she must stand in for what Lacan calls the Other with a capital O:what the analysand considers to be radically foreign, strange, not me. This is not the analyst’s final position, as we shall see, but it makes clear why analsts must keep their personal feelings and character out of the therapy, revealing as litte ass possible about themselves. Every individiaulizing feature of the analust stands in the way of the analysand’s projections.


    Comment by parodycenter — 14 May 2007 @ 11:07 pm

  6. When the analyst is viewed by the analysand as just another person like anyone else – similar to the analysand – the analysand is likely to compare himself to the analyst, imitating him, ultimately competing with the analyst. Such a relationship Lacan characterizes as the Imaginary and by this he does not mean that the relationship does not exist, he means that it is dominated by the analysand’s self-image and the image he or she forms of the analyst. Imaginary relations are dominated by rivalry, the kind most of us know from sibling rivalry.


    Comment by parodycenter — 14 May 2007 @ 11:12 pm

  7. One patient manifested his grudging acceptance of this sort of relation when he said to his therapist:

    Ktismatic I hope that with this quotes I have given you a foretaste of Fink’s highly informative and clearly written book. Quoting further would be a repetition ad nauseam for me, while you would get a fragmentary account of the therapy which won’t help you much in your queries. We might have a productive discussion though once you have read the book.


    Comment by parodycenter — 14 May 2007 @ 11:19 pm

  8. will this work? I’ll now try to patch in my longer comment that got spammed…

    Parodyc (pronounced “paradise”?) –

    Thanks for the information and observations. It looks like you’ve had your hands full on your own blog, so I appreciate your taking the time. I just got done writing probably a thousand word reply which erased as soon as I hit the “submit” button — on my own fucking blog! — so now I’m more pissed than is warranted. I’ll be less precise perhaps this time. I’ll likely have a look at Fink’s book, but probably not for a couple of months, which means I’ll have to marshall on with currently available resources.

    Lacan decenters the subject in a way that the ego psychologists clearly do not. In this post we see a dance of alternative ego manifestations entering into various kinds of relationships. In Lacan, alternatively, you have the impassive Other acting as a kind of oracle of the unconscious. For the analyst to be a placeholder for the absolute Other and to be a co-explorer of the unconscious is to immerse himself simultaneously in the subpersonal and the superpersonal registers. This must be rather disconcerting for the analysands.

    Insofar as the analyst is unwilling to keep his or her own personality out of the analytic relationship (ie resist being a placeholder for or representative of the analysand’s unconscious), he or she reinforces the assumption made by most new analysands that the analyst is a person more or less like themselves. This then is not a sense of a shared relationship between individuals but rather of the therapist being a projection screen onto which the client can impose his own image? From my perspective “a person more or less like myself” is one whose personality enters into the relationship. It sounds like the analysis proceeds by the analysand coming to realize that the analyst is instead entirely Other. This would seem a matter not of the analyst changing his self-presentation, of erasing himself, since he seems to have from the beginning presented himself as a cipher. Isn’t it rather that the analysand comes to abandon certain expectations of how the analysis will transpire? There will be no alignment of horizons or taking on the client’s perspective or validating the client’s self. Instead there will be a joint exploration of the unconscious by parts of the self that aren’t ego-controlled.

    Lacan’s neutrality of the analyst follows from Freud; the relational-interpersonal analysts don’t think it’s possible or even optimal, based in part on the stuff I’ve talked about on recent posts. An analyst emits affordances that make him a virtual fulfiller of relational desires, despite conscious efforts to suppress any sort of responsiveness to the client’s efforts to engage in relationship. Although maybe the jarring effect is part of the “theater” of Lacanian therapy: this analyst is purposely presenting me with an inhuman persona in order to jar me into a different register of engagement.

    the other that speaks inadvertently, in the slips and craks in the analysand’s discourse. This fascinates me. I envision a scenario in which the analyst, silent until now, suddenly interjects a seeming non sequitur. Because I have come to see the analyst as Other, I regard this strange verbalization as oracular, gnostic, the pronouncement of the Master of hidden truths. But it’s not so much an interpretation of the unconscious as a giving voice to it, no? So that eventually the client too begins to speak the unconscious without trying consciously to translate or interpret it? So it’s not so much a matter of resolving inner conflicts or symptoms, but rather of opening up another register, of getting the ego and the Other out of the way of the direct expression through language of the unconscious.

    This unseating of the ego, opening up awareness to the subpersonal desires and the superpersonal territorializations of the Other, is where Deleuze & Guattari follow the trajectory of Lacan. For D&G the “body without organs” is both the subpersonal source of desires and differentiation (the realm of the unconscious) as well as the sociocultural context that is the source of territorialization and channeling of desires (the realm of the Other). There are other areas of disagreement, but I think here in particular we see Lacan and D&G on the postmodern side of the divide from ego psychology and relational analysis. Where these latter participate in postmodernism is in recognizing that no hidden preformulated sure truths are going to be revealed, that interpretation and creation are part of the expression of unconscious material.

    Freud, Lacan, Reich — none of these guys has much of a presence in psychology as an academic discipline. They appear much more prominently in cultural studies: literature, film, social constraints, etc. I think in part this is because artists are always looking for a more direct channel from the unconscious into the artistic expression. Me too. I have a hard time, though, with some of the theoretical underpinnings related to etiology of personality and neurosis, etc. Perhaps decoupling the channeling praxis from the metapsychology and ideology is something I need to consider. I’m moving through a slow arc, trying to link a variety of ideas together that I haven’t tried to synthesize previously. I think the decentering of self and the dethroning of ego are part of what needs to happen. I also acknowledge the importance of unconscious experience that both bubbles up from underneath and that immerses us in itself. And I do sense that the kind of discourse that transpires on your blog manifests a different, perhaps a more direct, channel from the unconscious to written language.


    Comment by ktismatics — 15 May 2007 @ 10:35 am

  9. I have a hard time, though, with some of the theoretical underpinnings related to etiology of personality and neurosis, etc.

    I really think that’s because you haven’t read the right books – this Bruce Fink is certainly on the must-read list. And believe me, I went through enough Lacan books. After Fink, it all sort of came into place.


    Comment by parodycenter — 15 May 2007 @ 9:45 pm

  10. I guess I’ll have to live with a desire that ends in lack — at least until I get hold of Fink’s book, which I will definitely do. Given that it’s so difficult to figure out what Lacan means, one has to wonder whether Fink is buggering him in order to spawn some monstrous Lacan-Fink offspring.


    Comment by ktismatics — 15 May 2007 @ 10:07 pm

  11. one has to wonder whether Fink is buggering him in order to spawn some monstrous Lacan-Fink offspring.

    No, I don’t think so. The book is faithful to what I read of the original Lacan. I also think he is a member of the Lacanian circles, which presumably one couldn’t penetrate if one was motivated solely by buggery. And it’s not a complicated long read, so you can proceed directly.


    Comment by parodycenter — 19 May 2007 @ 2:11 am

  12. Okay, maybe two months from now — too much trouble right now moving what books I’ve got back to America.


    Comment by ktismatics — 19 May 2007 @ 4:07 pm

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