HOW TO BE FSyCHOA NALYZED By Vera Derer

DESPITE this being Election year, one suspects that readers of Men- tal Health may be not so much in- terested in an analysis of the political parties as with an analysis of them- selves. Unfortunately, though there are books telling the analyst how to conduct an analysis, there are none

telling the analysand1 how to do so.

Freud, who was exceedingly fond of metaphor, likened the situation of the analysand to that of a horseback rider who believes he controls the horse when in fact the horse controls him. These notes may help you restrain the horse from going too far. Assuming you have decided on

analysis, you still have to decide whether to analyse yourself. The main flaw of self-analysis is the counter- transference (Main). A possible middle course has been suggested by Men- ninger, viz.: having an analyst who never speaks. "The analyst contributing his consistency of appearance, atten-

tion, interest and audience."

The initial interviews A careful appraisal of the analyst

from the beginning is invaluable in

planning the "therapeutic campaign". Study of the famous waiting-room in- cidents (Introductory Lectures No. 16) shows that it is vital that behaviour be impeccable from the outset. The

patients who left Freud's consulting- room door ajar, though they went

down in analytical history, started their analyses off on the wrong foot and were dismissed by Freud as belonging to the rabble, as well as being given "a sharp reminder". A beginner's tendency to avoid is to

look round from the couch to see if the analyst is still there: only to find that he is. Actually had he not been, nothing would have been achieved.

Early analysands were usually Egypt- ologists, archaeologists or members of

the noblesse. Discussion of types of

analysands focuses attention on the unlikelihood of those with an English background becoming classic cases.

Fraulein Anna O. and little Hans were

Viennese, Schreber a German, and the Wolf-man a cosmopolitan Russian. There is no way in which your case can be ensured a place in the literature unless you write an account yourself- This has been done by at least one enthusiastic and one less enthusiastic lady analysand, both published by the same enthusiastic publisher (G .... Z)-

Transference phenomena Originally, transference meant the

"reincarnation in the analyst" of im- portant figures from the past of the

analysand, but the analyst today can encompass all the figures in the

analysand's life. For example, you g? to the dentist: he is the dentist; you g? to the tailor: he is the tailor; you g? to the House of Commons: he is the Prime Minister. Hence you should never overestimate the importance of what happens to you. What is really important is what is happening to your analyst. When analysands complain that their analysts do not understand them, it is invariably found that in fact they do not understand their analysts-

Couchmanship Most analysands have considerable

natural capacity to obstruct treatment- Nevertheless, much is said in the hey- day of the positive transference which is regretted in the middle years. A

recurring problem is how to escape the Scylla of sophistication as well as the Charybdis of ignorance. For example- the analysand who knows that his

utterances are really allusions to other things might be tempted to talk directly of the other things. He may thus con- fuse the analyst who may think the other things he talks about are allusions to the utterances he would have made, had he not spoken directly of the other

1 Analysand = patient/person who undergoes psychoanalysis.

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things. (Cf. Freud "Jokes..the famous story of the Cracow-Lemberg dilemma, p. 115.) Yet you must learn the psycho-

analytical language if you are to avoid mistakes, such as that of the scientifi- cally-minded analysand who thought that sublimation meant that one is put into a cauldron with a fire lighted underneath. Admittedly this is a dif- ficult concept. For instance, if a con-

vinced vegetarian changes his occupa- tion and becomes a butcher, or if a fireman starts fires in order to have the opportunity of extinguishing them, they have betrayed that their interest in

Vegetables and fire-fighting "has not

really been of the sublimation type" (Fenichel).

How to free associate Free association, "the first point of

attack of the resistance", is the field Par excellence for specialist know-

ledge. Older readers may recall the

logical positivist cult.1 At that time, associations were fashionable as to

whether a reaction formation is a con-

tradiction, or whether the set of sen- tences said to be psychoanalytical theory is meaningful. Nevertheless, on the whole analysands sadly overdo

Preparatory work on their "free asso-

ciations". They forget that, whatever they say, they lay themselves open to interpretations.2 Freud has compared the position of the analysand con-

fronted with interpretations to the criminal confronted with his crimes. Denial is no proof of innocence. There is room, however, for manoeuvre in the way we accept interpretations. One

analysand greeted his analyst's inter- pretations with shouts of "Touche", a la Thurber. You must not forget that actions are also interpreted. For instance, to come early = anxiety; late = hostility; on time = obsessional traits; to greet the analyst with the word "goodbye" = a strong negative motivation; to send him a greetings card without a stamp, or to make fee associations = ambivalence, etc. (The problem of how to believe interpreta- tions is beyond our scope.)

Perhaps part of a session, with com- mentary by Dr. Sado Masochisti (taken from a paper previously unpublished in the International Journal), may help readers at this stage. (1) Analyst: "What are you thinking

about?"

(2) X: "What am I thinking about?" (3) A short silence. (4) X: "I have the phantasy I am

being analysed." ' A fine example of the well-known academic

Phenomenon: "the narcissistic overvaluation of sHall differences" (Balint).

s Interpretation = the term used to describe the activity of the analyst in translating what the analysand says into psychoanalytical language.

A careful appraisal of the analyst is invaluable A careful appraisal of the analyst is invaluable

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(5) Analyst: "What are you feeling?" (6) A highly charged silence. (7) X: "I smell smoke."

(8) Analyst: "What do you associate with smoke?"

(9) X: "Where there's smoke, there's fire."

(10) ^4 long silence.

(11) X: "Burning, fire, a house burn-

ing down, conflagration." (12) Analyst: "Conflagration, con-

fabulation. I am the house and

you wish to annihilate me by fire and burning."

(13) A bell rings. Notes:

(1) The analyst may be a woman.

However, to change the sex of one's analyst "whenever an

analysis becomes too difficult is not a general panacea (Fenichel).

(2) X is not the patient's real name. (3) See (6). (4) No comment. (5) Analysands are often asked what

they are thinking or feeling. (6) Silence plays an important part

in analysis. Highly charged silences are more common in

private practice. Cf. Foulkes and Anthony: "There are benign silences, perplexed silences and

explosive silences." (7) See (4). (8) Taking into account all the data

to hand, it may be safe to make the assumption that even if the

analyst asked "What does smoke bring to your mind?", the re-

sponse would not be different.

(9) A rather topical association. See Gaston Bachelard, The Psycho- analysis of Fire (1964). "Is fire a symbol of the generative seed, flame a sexual metaphor, and heat a fundamental image of the womb?"

(10) See (6). (11) See (4). (12) Note the analyst is the house, as

we would have supposed. See "Transference Phenomena".

(13) If X rose from the couch at the sound of the bell he would show that he was avoiding interpreta-

tion and thus guilty of what is

technically called "a flight fron1

insight" or "a flight into reality" Unfortunately, the end of this recorded session is damaged, and we do not know the outcome.

How to be helpful to your analyst There are analysands who through-

out their analyses were in a state of

"co-operative antagonism", but no

doubt Mental Health readers would wish to be more helpful to their analysts. Though unable to afford to

follow the example of the analysand who engaged concurrently a second analyst, so that he could help his first analyst (Stekel) along; your enthusiasm can be shown in other ways. Commended is the practice, re-

marked on by Freud at an early stage (Introductory Lectures No. 19), of the analysand making a thorough study of the literature. Bear in mind particu- larly The Interpretation of Dreams vicariously described as the "Magna Charta" of analysts (Menninger) and as their "Bible" (Foulkes and An-

thony). By such exertions, analysands may, on pertinent occasions, be able to point out any divergence on the part of their analyst from the rulings of

psychoanalytical authorities. (By the way, dreams?"the Royal

Road to the unconscious"?can be ter-

ribly revealing. Fenichel recounts that "a patient used to dream exclusively about food, and the analysis apparently made no progress. It turned out that he

actually did not have enough to eat.")

Analysis terminable and interminable

Sometimes, resistances take the form of a belief in an analysand's mind that he wishes to terminate treatment, say? because his symptoms have gone. Such a belief is, of course, an indication that he prefers even to give up his

symptoms and to live in a state of

pseudo-health rather than to continue- metaphorically speaking, to face blS

analyst. 262

Outcome "Where Id (instinct) was, there shall

ego be." Freud's maxim applies to the internal mental personality. Does one's new status as an analysed person show externally? One hallmark of the ex- analysand is in the strength of his con- viction, for or against analysis in general and his analyst in particular.

| Some who commence analysis with an accumulation of lifelong grievances against all and sundry end it with these grievances successfully concentrated

entirely on the person of the analyst. Stekel movingly describes one such crude analysand who "wanted to go on smiling at the doctor's ineffectual efforts and to come off victorious in the long tussle". It became this analy- sand's life-purpose to prove that his

analyst had not and could not cure

him. However, today there is a more

civilised atmosphere than in Stekel's time, and, in any case, since analysts talk more and analysands less, most

analyses are prolonged indefinitely.

Those that do end, tend to do so in an enthusiastic atmosphere: the ex- analysand may still have various symp- toms, but at least he knows why he has them. He has not so much changed, but rather he sees himself as he is, and does not seem to mind. Such an out- come may disappoint friends who had expected overt changes. Nevertheless, it is becoming widely accepted that any expectations as to outcome are signs of resistance, indicating that the person having them has not been fully analysed.

Expert opinion remains divided: the Glover School thinks the outcome of

analysis is immaterial; the Eysenck School thinks there is none. Both schools seem agreed that analysands as such have little to contribute on this

point. Analysands may, however, feel reassured by the fact that they do make their "small contribution to cultural resources" by helping through their "economic resources... to maintain the psychoanalytical profession" (Brian Farell).