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.