Inculcating Psychological Mindedness for Use After Treatment

As so often happens, a comment on Twitter makes me think of a book I read that may have something useful to offer the conversation. In this case, it was a question about post-treatment goals in and for therapy, and whether they diverge that much between CBT and psychoanalytic practitioners. In particular, it was asked whether both traditions seek to create a capacity for what (following Nina Coltart) I would call a healthy psychological mindedness (a lack of which during intake bodes ill, as she says, and my experience confirms, for successful treatment). 

The question of post-treatment goes back, of course, to Freud's very late essay, "Analysis Terminable and Interminable," and its welcome ambivalence about whether one can ever be truly and totally and completely analyzed. I was very heartened precisely by his ambivalence in this essay. I also found it edifying that Freud seemed to recognize benefits might continue on even after analyst and analysand formally cease to meet together for sessions. 

In this regard, I often think of something Adam Philips (he whose books are so essentially aphoristic in nature) once said, which I have found incredibly true in my own life: "the cure can begin only after the treatment has ended." More recently, he has returned to the whole vexed question of cure in what I think is one of his best and most important books, The Cure for Psychoanalysis, which captures in one place a theme he has often advanced in just about every one of his previous books: about the sad irony that psychoanalysis has become--in many places, not least training institutes--a hidebound ideology instead of a means to free people from the prison of ideologies. 

For me, my first analysis (four times a week on the couch for almost seven years) ended in late July 2000 but I have found myself living from that in some useful ways ever since. And in fact I think the "returns," far from diminishing, actually grew in the years after treatment came to a formal end. (I would say the same thing of my second analytic therapy, which is ongoing.)

One person who has thought about this in an elegant and useful way is Fred Busch in his 2013 book, Creating a Psychoanalytic Mind: A Psychoanalytic Method and Theory.

Busch seems a very interesting fellow, and quietly understated pioneer of some sort. As he recounts in the introduction to this book, Busch was one of the first clinical psychologists to be admitted in the 1970s to psychoanalytic training at an American institute. American institutes, unlike those in Canada, the UK, and parts of Europe and elsewhere, generally have been extremely reluctant to admit any but psychiatrists or those with medical degrees. 

In this, they deplorably and unjustifiably take a different tack from what Freud recommended in The Question of Lay Analysis, a book where Freud memorably says two groups should most certainly keep their hands off psychoanalysis: doctors and clergy! He also coins a memorable phrase about analysts being "secular pastoral workers," a phrase to which I gave some attention elsewhere. 

I will not go into Busch's entire book, which I encourage everyone to read, but simply make a few brief observations based on notes I took years ago when first reading it.

Busch understands analysis to consist of three phases:

1) The first phase is when the patient comes to be familiar with his own inhibitions and restrictions that keep him from living: until the patient can wonder about his lack of wondering, wondering is not possible. This phase, later in the book, is called one of self-observation. 

2) The middle phase of an analysis is the creation of a "psychoanalytic mind," that is, learning to observe one's own mind and its sequence of free associations. Such a psychoanalytic mind is necessary if the analysis is to bear long-term sustainable fruits in one's life. It is necessary, that is, if the patient is to be freed from the "slavery of repetition compulsion" and instead freed to "think about thinking." Later in the book Busch calls this phase one of self-reflection. 

3) The terminal phase of an analysis consists of a deeper psychoanalytic mind more completely free from deceptions in understanding one's associations with greater veracity. Here the analysand can "play, muse, reflect, and interpret her own associations." This phase Busch later calls self-inquiry. 

Busch says that part of his practice consists in seeing patients for a second analysis. They have benefited from their first analysis, but from that largely derived only knowledge of their unconscious--an "object," as it were, rather than a process. And for Bush, "the process of knowing is as important as what is known." This, for me, is the very obvious difference between my first analysis (which I wanted simply to know what was unconscious and bring it forth for rational scrutiny and, especially, control!) and my second, which has focused much more on the process of knowing and far less on the contents. 

Busch continues in this vein, saying that he offers a different goal for analysis which, classically, has held up the importance of a state of knowing rather than a process of knowing. In the former, we come to know consciously what was previously unconscious. In the latter, the patient gains an understanding of how his mind works and how it affects him. Both offer freedom, albeit of a different degree and type, but Busch suggests the freedom of a psychoanalytic mind, with a process of knowing--in addition, and perhaps even preferable, to--what is known, may be of greater long-term benefit. I would heartily agree. 

A Note on Four Psychoanalytical Biographies

I have been a tireless reader of biographies at least as far back as the seventh grade. Since the summer began, I've had a chance to read four biographical studies, none exhaustive, and each in most cases covering terrain I was at least moderately familiar with. But they were enjoyable nonetheless, each in their own way, and each also filled in some gaps in a welcome way, so I thought I'd offer a few notes on each in case others might wonder about the wisdom of picking any of these up.

I begin with Joel Kanter, ed., Face to Face with Children: The Life and Work of Clare Winnicott. I should confess two biases at the outset: first, anything with the word "Winnicott" in the title is invariably going to attract my attention. Second, Joel Kanter is one of the conveners of an international study group on psychosis that it has been my very great privilege and delight to be part of.

That said, this book fills a huge lacuna. Clare Winnicott's husband Donald Woods is of course world renowned. But her own life as a clinical social worker and writer has been largely left in his shadow, which is completely unjustifiable given the scope of her contributions in their own right--to say nothing of the huge and countless ways she helped her husband achieve so much. 

Kanter has assembled a worthy cast of people to write about her works, and has reprinted several of them which were originally published decades ago in obscure places. But the crowning glory of this book is the 90-page biography he writes at the outset, which is superb. Buy and read the book if only for that reason. 

I have been very interested in reading more of Sandor Ferenczi for some time, and recently stumbled across Sandor Ferenczi: Reconsidering Active Intervention by Martin Stanton. It is a unique book: in fact I would call it a prolegomenon to a proper scholarly biography. That diminishes Stanton's labours not a whit, and in fact he himself more than once says he is merely trying to lay out the parameters of what a full biography of Ferenczi needs to wrestle with. 

There are at least two significant gifts offered by this book. First, Stanton has performed a very great task by merely assembling a chronology of the Hungarian analyst's life, farcing into each entry not just significant events in Ferenczi's own life, but also significant developments in the wider psychoanalytical movement in the opening decades of the last century. Thus we see when and where Freud and Ferenczi first meet, and Jung and Ferenczi, and so on.

Second, he has put together thematically named chapters that introduce the reader to some of the concepts and practices unique to Ferenczi, with liberal quotations of his writings as well as reactions, where known, to his writings from Freud and Jones, Jung and Klein, and others.

Next up is Gérard Bléandonu's Wilfred Bion: His Life and Works. It is an odd book in some ways, starting with the fact that a French psychiatrist wrote the first biography of an English psychiatrist and psychoanalyst, which was then translated from French. As someone who, many years ago, worked in scholarly translation of works between French and English (dealing, at the time, with Canadian governmental policy on HIV/AIDS), I know what a vastly time-consuming and painstaking process it is. I also learned that it's generally inadvisable to translate from translations. 

Nevertheless, in a way not entirely dissimilar to the Ferenczi study noted above, Gérard Bléandonu has written a life that spends most of its time discussing Bion's texts. I would have welcomed more integration of the theoretical chapters with Bion's life, which seems very much confined to the introduction to the book. By the end of the book one does not feel that one has penetrated very far at all beneath the surface of Bion's life, which is perhaps how he wanted it. 

So I would not consider this the definitive study of Bion by any means, and once again wonder: is anyone working on such a biography? If I had time and money I'd gladly fly to England (and anywhere else!) to luxuriate in archives and private collections of letters and whatever else I could lay my hands on in order to write about Bion. (For some unanalyzed reason, I have long wanted to write a biography. I thought at one time I might do the moral philosopher Alasdair MacIntyre, but a new study of his life has just been published--once more first in French!) 

Finally we come to Brett Kahr, The Legacy of Winnicott: Essays on Infant and Child Mental Health. I picked this up not only because I respect Kahr and have enjoyed previous works of his, but for two other reasons at least: the inclusion of an interview with Winnicott conducted by no less a figure than Paul Roazen; and then a really compelling essay by Susie Orbach, "The False Self and the False Body." 

If you do not know Roazen's work, then you should. He bids fair, more than a decade after his death, to retain (to my mind at least) the post of doyen of historiographers of psychoanalysis, at least in the anglophone world. Several of his books have been utterly fascinating, not least his Freud and His Followers as well as Meeting Freud's Family. 

It was Roazen, if I recall correctly, who back in the 1960s discovered and published the then hugely scandalous fact that Freud had analyzed his own daughter Anna, which by that point almost everyone was at pains to conceal, not least since she didn't die until 1982. On the topic of Anna, I've read two biographies: the one by Robert Coles (which is workmanlike but all of his biographies tend to feel just a shade too beige in some ways) and the more comprehensive one by Elizabeth Young-Bruehl, in an updated second edition from 2008.

I have known of Orbach's work for a while, but not read much. Still her essay in this collection is extremely valuable for its steely eyed critique of Winnicott's ideas of the true and false self. Orbach argues that too much of the reception and use of these ideas by and after Winnicott posit some kind of chasm (bad!) between them, on the one hand, or some kind of magical integration on the other (good!). But, she argues convincingly, we cannot and must not allow them to be seen as thus divided because in reality aspects of the true and false selves are always mixed up with each other. The therapeutic task thus becomes not a perfectionistic one (how very unWinnicottian!) whereby we totally separate or totally integrate the two, but rather an asking of the question: how ought they to be together, and what can be realistically disentangled and perhaps changed, and what cannot? 

In sum, each of these books was interesting, though none, admittedly, was as moving and fascinating as the last major biography I read, Gail Hornstein's lovely study of Frieda Fromm-Reichmann (about which a few brief comments here though I really should go back and write more about her). 

Next up: I will likely shift away from psychoanalytical biographies for a bit as I've just ordered Simon Sebag Montefiore's Stalin: The Court of the Red Tsar. I was tempted to do so after this highly entertaining (can one say that?) interview with the author here.