Schlesinger on Psychoanalysis

Schlesinger on Psychoanalysis.

 Herb Schlesinger presented the 47th Freud Anniversary Lecture at the Psychoanalytic Association of New York on April 21st on how we know we are doing psychoanalysis.   We will summarize that presentation in the near future.  Until then, here is a review of his gem-like classic, The Texture of Treatment. It is reprinted from the Hebrew, Sichot.  N. Szajnberg, MD.

 Book Review: The Texture of Treatment: On the Matter of Psychoanalytic Technique.  Herbert J. Schlesinger (2003) Analytic Press. 
By Nathan Szajnberg, MD and Keren Segal, BA

 

Herb Schlesinger spent five decades analyzing and writing to prepare for The Texture of Treatment, this too brief, but glistening gem: like a diamond, it captures apparently mundane light in various facets and enhances its beauty.  

“In the beginning … was technique.”  A provocative — Biblical — first line. It reflects the style of his work: crisp, concise, sincere, honest, yet humor-twinged.

This book is like Strunk and White’s classic, Elements of Style (1999): for writers, a beginner’s guide; a veterans’ reference.  Follow its suggestions thoughtfully, critically, then you will write well. 

A man of words, Schlesinger, invites us to think about our argot.  “Consider transference … resistance, defense and development as … processes rather than substantives … as points of view.”  Psychoanalytic phenomena evolve, happen, with mutual reflection (1976).

He reminds us of basics; rethink impasses, distinguish endings, quittings, stoppings, finishings, stalemates, terminations and the interminable.  Recall that psychoanalysis begins with an ending: the analysand at wit’s end with failed attempts to resolve problems befoe turning to analysis.

The psychoanalytic relationship is “instrumental,”  — there to accomplish something — different than marriage, friendship or parenthood, which exist for their own sake.  If we trust transference, then we not only facilitate its development, but also its “cure,” its resolution. 

Mini-terminations occur when the analysand has accomplished a significant piece of work. Indications include: slower work pace; lack of direction; slackened engagement; vagueness; lateness, cancellations…and most frequently, anxiety that the analyst wants to stop treatment.

But, these can also be signs of resistance.  Our task  — recognize signs; clarify meanings.

He questions. Why treatment now?  Some capacities for success: sensitivity versus obliviousness; engagement versus detachment; psychological-mindedness versus concreteness; curiosity versus indifference; externalizing versus internalizing; regression tolerance versus regression seeking; free-association versus plodding; humor versus literal-mindedness.   We have continua of these capacities: treatment develops greater freedom.

Schlesinger addresses impasse, that uncomfortable stasis that is preferred to risky movement.  Impasses (Wallerstein, 1967) can range from the doldrums to “noisy” psychosis.  It is an (unspoken) unsettled disagreement or argument.  Groundwork for impasses includes a dependent sexual transference or unanalyzed attachment.  It can be both a collusive repetition compulsion and an occasion for productive work.

The Texture of Treatment guides the analyst’s hand to sail out of the doldrums.

He defines technique and redefines it, like a theme with variations.  “Technique… (is the psychoanalyst’s) responsibility .. to conduct a rational treatment” (p. 2); to raise the level of communication, decrease tension:  transference-charged speech is loaded with action potential.    Technique’s major goal : promote the analysand’s activity (p. 278).

Avoid semantic errors – questioning, obliqueness, subjunctives, qualifiers, passive voice:  speech reflects thinking.  Stay a half-step behind the patient, and with the patient (258).

Listen.  Avoid making nouns from verbs; skip conjunctions.  Watch for topic changes, vague references, shifts in emphasis, private language, opening phrases such as “I know…” “ I see…” “To be perfectly frank…” (Compare this to Paul Ekman’s approach to reading (self)_deceits in emotions.)

Neuroses?  “Resources… defending against unrealistic and anachronistic dangers.” ( 84).  Many feel it is something they have rather than something they do(199).

Transference?  It is conservative, keeps things the same (57).  It is enactment.  He prefers “metaphor” to the Latin transference (Szajnberg, 1986), transporting an image from one time/place to another.

Interpretation either reduces a complicated phenomenon to simpler components or reveals the complexity of an apparently simple manner, or both.

Psychoanalysis?  A process that clarifies: 1. The nature and source of unconscious conflicts in fantasy; 2. Why compromise formations made sense; 3. Why these persist anachronistically. (28). Or, a process to relieve pain by altering the circumstances leading to it. (10).  A situation of “unvarying conditions and few distractions.” (69).  Its general goal is to live more in a real world free of compulsion. (167).  Psychoanalysis seeks patterns of events and cures by restoring memory (234).

He suggests landmarks for termination  1. Making and sustaining attachments; 2. Tolerating regressive pulls; 3. Tolerating separation, loss and surrendering fantasized gratifications.

I would say more, but to follow the laconic model of this book, I say enough to reveal and yet not too much to lose the reader’s interest. Let’s go to the denouement. 

Schlesinger’s thinking is like old Volvos: solid, reliable, good for the long-term and equipped with gadgets to make a long journey safe and fruitful.  It gets you safely where you really wanted to go.

Let’s end with Schlesinger’s most recent book, Promises, Oaths and Vows. He writes, “[the psychoanalyst promises] steadfastness, selflessness, patience and devotion. This promise is one sided. We expect nothing comparable of the new patient.”

The Texture of Treatment is built upon this solid foundation.

 

Click Here to Read: Abstract of  Disclosing information about the self is intrinsically rewarding by Diana I. Tamir1 and Jason P. Mitchell in the Proceedings of the National Academy of Science Journal.  The full article is available for purchase.