Friday, March 15, 2013

Jay Greenberg - Relational Perspectives on Psychoanalytic Technique

"Patients sense and react to their analyst's inner relationship to the received method. Most patients are well aware of one or another version of the analytic frame. Even those who are not are likely, sooner or later, to know something about the analyst's investment in his or her role as a analyst. Some patients welcome the idea or even insist that the analyst tailor technique to suit their needs; others feel safer when the analyst sticks firmly to established ways of doing things that reflect long-standing personal values and choices. I have worked with people who get into a competitive struggle with the analytic technique, which becomes a kind of personal rival. They have told me that I must care more about my role, or about the rules I am supposed to follow, than I do about them. It is as if my relationship to Freud matters more to me than they do. For such patients, bending the rules is a gesture of loving concern and invites collaboration. But for others, the same kind of flexibility is a threat — perhaps it makes them feel too powerful in their competitiveness or even in their sadism.

So we are left with analytic dyads that are vastly different in their attitudes (whether patient and analyst have similar or different feelings) on any particular issue. With this in mind, I would like to introduce a concept that I will call the interactive matrix. The interactive matrix is a construct that can help us characterize the make-up of a particular dyad. We can use it to specify the beliefs, values, commitments, hopes, needs, fears, wishes, and so on that both analyst and patient bring to any particular moment in the treatment. These ideas and feelings, in turn, become important determinants of the meanings with which each participant invests the events of the analysis.

The interactive matrix is a third step in the evolution of our thinking about method. First there was Freud, who taught — despite his occasional warnings to the contrary — that certain rules of technique can be applied across the board to all analyzable patients. The fundamental rule and the rule of abstinence set the frame within which an analytic process can get going. For classical analysts, these rules can and must be specified in advance; they become conditions of the treatment. The basic rules generate derivative rules: the rule of anonymity, the principle of neutrality with its imperative to avoid giving advice or encouragement, and rules against making any kind of small talk are all cases in point. Psychoanalysis is by definition treatment conducted according to these rules, with a properly selected patient.

The second step came with the realization, by analysts of many different theoretical persuasions, that numbers of patients who could participate in an analysis in the sense that they could work with their transferences and their resistances were not capable of tolerating the austerity of standard technique. Early on, this was discussed in terms of some patients' need for a more actively established alliance with the analyst, an alliance that was explicitly viewed as a departure from the older rule of technical neutrality (Greenson, 1967). Recently, this approach has broadened considerably. Technique, it is argued, must be tailored to the capacities of the individual patient. We cannot say in advance how active the analyst ought to be, how warm or supportive, what the correct timing of interpretations is.

There is considerable overlap between this approach and the one I am advocating, because both allow for considerable technical flexibility. But there is a substantial difference, because in this second-stage method, the variations depend exclusively upon the needs of the patient. This is usually couched in terms of developmental level and/or nature or severity of psychopathology. The empathic analyst, observing his or her patient with no methodological axe to grind, determines what the patient can use. Drawing from an enlarged bag of technical tricks, the analyst intervenes correctly, and the treatment stays on track.

I want to be clear that I admire and use a great deal of what has come out of this second-stage approach (see, for example, Pine, 1985). But I also want to point out that it takes little account of the interaction between patient and analyst, because all variations in technique are attributed to the needs of the patient. The analyst remains a detached, although empathic observer of the patient's process. Despite Freud's warning that his technical recommendations are "suited to my individuality," even in second- stagethinking no consideration is given to the analyst's need to establish an atmosphere within which he or she can think and respond freely and creatively. Thus, the particular analyst's hopes, fears, and beliefs are not taken into account as legitimate determinants of technical choices.

Recently, a number of authors have addressed the nature of the psychoanalytic process in a way that highlights the individuality of the analyst as a force in shaping the experience of both participants in treatment. Changing views of the ubiquity of countertransference and its influence on the relationship between analyst and analysand (Jacobs, 1991), the role of mutual enactments as determinants of the course of every analysis (Chused, 1991; McLaughlin, 1991), and the analyst's personal contribution to the patient's transference experience (Boesky, 1990; Gill, 1982) each sensitize us to the inherently interactive nature of the psychoanalytic situation. But, in one of those dialectical swings in the relationship between theory and practice that characterize the evolution of psychoanalysis, at this point in our history, technique lags behind conceptualization. The implications of an interactive model of the psychoanalytic process have not yet been fully integrated into our thinking about method.

Third-stage approaches to technique—embodied in the concept of an interactive matrix—grow out of our evolving understanding of the psychoanalytic process. Thus, the third stage represents a far more radical break with tradition than the second, because its approach to technique reflects the belief that everything that happens in an analysis reflects the personal contribution of each participant. There is no such thing as a "simply" analyzable patient in this model, one who will respond to standard technique by free associating with unconscious resistances providing the only roadblocks. Neither is there an "average expectable" analyst, capable of following prescribed rules without intrusions from his or her own personality (see Hoffman's [1992] critique of "technical rationality"). Instead, we have to consider the genuine differences in sensibility that characterize, for example, my supervisee and me around our feelings about apologies. The concept of an interactive matrix is necessary if we take seriously the idea that there are always two people in the consulting room.

In developing the concept of the interactive matrix, I have been influenced by the philosopher Ludwig Wittgenstein (1953), who wrote about the way languages work. The meaning of a word, Wittgenstein wrote, can be known only when we understand the broad context within which it is used. We cannot know what the word "means" to a person speaking it unless we know its function, unless we know what the speaker is trying to do with it. And we can never learn this by focusing exclusively on the word itself, we must look at its use within the overall structure of the language. Like Wittgenstein, I think of this idea in terms of the rules of games. There are games—football comes to mind—that sanction certain actions that in other contexts are considered criminal. Tackling somebody who is trying to get someplace quickly is an act of random violence on the street; in the stadium it can be a game-saving act of heroism. What the act means—what it is, really—depends upon the circumstances within which it occurs. We can say very little about one person tackling another unless we know what game they are playing.

Applying Wittgenstein's analysis to clinical process we can say that the interactive matrix establishes the rules of the analytic game in each individual treatment situation, and provides the context within which specific exchanges—including technical interventions— acquire their meaning. Saying this goes beyond maintaining simply that something does or does not work, and it implies much more than saying that different patients require different interventions. Rather, it asserts that we cannot even describe an intervention meaningfully without understanding the interactive matrix within which it is made."
(pp. 10-13)

Jay Greenberg (1995). Psychoanalytic Technique And The Interactive Matrix. Psychoanalytic Quarterly, Vol. 64, pp. 1-22

No comments:

Post a Comment

Note: Only a member of this blog may post a comment.