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Bachrach 2000
Bachrach 2000
To cite this article: Dr. Henry M. Bachrach Ph.D. (2000) Notes on Psychoanalysis,
Psychotherapy and Methodology, Psychoanalytic Inquiry, 20:4, 541-555, DOI:
10.1080/07351692009348906
Article views: 35
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Notes on Psychoanalysis, Psychotherapy
and Methodology
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H E N R Y M. B A C H R A C H, Ph.D.
Abstract
Dr. Bachrach is a member of the Faculty, New York Psychoanalytic Institute;
Clinical Professor of Psychiatry, New York Medical College.
541
542 HENRY M. BACHRACH
context of its time and purpose, and does not serve well as a scientific
definition of psychoanalysis. In fact, it could (and has) be used to
justify all manner of mischief. To cite an absurd example. One can
certainly see a patient once a month and attempt to deal primarily
transferences and resistances, but the resulting influences and
observations would hardly be comparable to what would be obtained
if the patient were seen three, five or six times a week! Note that
Freud was quick to observe that Adler or Jung’s methods, for example,
did not yield observations comparable to the observations elicited
by his methods even though they dealt with transferences and
resistances. This line is therefore not likely to be very helpful to our
inquiry.
One might also approach the problem through an examination of
“extrinsic” and “intrinsic” criteria of psychoanalysis, a venerable way
in which the problem been studied over the years. By extrinsic we
have meant matters such as the frequency of visits, use of the couch,
appointments of the analysts’ office, extra-analytic contacts, or
anything else beyond what is intrinsic to the analytic work. By
intrinsic we have meant the presence of a patient in need, the use of
free-association, the analyst’s empathic, non-judgmental, technically
abstinent and neutral attitudes single mindedly aimed at exploration
and understanding, the centrality of interpretation, and all else that
goes along with the possibilities for the expression and analysis of
transference/resistance configurations as they are repeated
(remembered) in the immediate and historical moment of the
analysand-analyst relationship. These intrinsic criteria have always
been considered the more important because they emerge directly
from a psychoanalytic theory of mental functioning, neurosogenesis
and therapeutics. Extrinsic criteria have been offered as a sort of
operational short-hand because it was widely believed that intrinsic
factors were dependent upon the extrinsic factors. However, there
546 HENRY M. BACHRACH
have always been gray areas and the correlation between extrinsic
and intrinsic has hardly been perfect. All analysts of some experience
have had occasion to have treated patients four or five times a week,
using a couch and maintaining all the fundamentals of the analytic
armature, in which the mutative processes associated with intrinsic
factors have hardly developed at all, or only to a very limited degree.
At the same time they have also had the experience of seeing patients
at a lesser frequency where the intrinsic factors have emerged along
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method. At this point I shall present and carry forward the outlines
of this analysis. To begin, the psychoanalytic method starts with a
patient in need whom you ask to tell you about themselves and their
problems. This Rapaport referred to as the clinical method. What
invariably occurs, if you do not interrupt or re-direct the patient, is
that as the patient will tell you their story. The narration will begin
with the present and move backward in time toward their view of
how things got that way. At some point the patient will pause and/or
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shift to another topic. If you begin your inquiry with a basic postulate
of psychic determinism, it follows that you must account for why
the shift has occurred at this point in time. This postulate requires
that you must assume the pause or shift is somehow connected to the
whatever the patient just said which leads to a concept of association
and the continuity of mental activity, that there is a causal connection
between what the patient just said (or thought) and the pause or shift.
It is the combination of the clinical-historical method along with the
postulate of psychic determinism that leads to a concept of
unconscious mental activity because the association and continuity
must be accounted for and there is nothing that requires that the patient
must be aware of the connection. In fact, in applying this method
and principle one observes that people often cannot convincingly
tell you why they may have paused or moved on to another topic,
which then leads to the idea that mental activity occurs at varying
levels of consciousness. Following this line of reasoning, a concept
of unconscious mental activity is not a basic postulate of
psychoanalysis, but a necessary consequence of what follows when
you apply the clinical-historical method in combination with a
postulate of psychic determinism (Shevrin, 1984). However, this
consequence does not tell us anything about the nature of unconscious
mental activity. What the nature of this activity is follows from
observation. Whether unconscious mental activity is static or
dynamic, whether it is best conceptualized by topographic, structural
or other models follows only from efforts to provide the best
understanding of what one observes in the most parsimonious way
that does not conflict with anything else we know that is
methodologically germane about the nature of mental activity, i.e.
that it can not occur in-vitro because of insufficient cerebral
mylenization. None of this, however, is distinctively psychoanalytic.
Association, continuity, intrapsychic conflict and unconscious mental
functioning are only consequences of the clinical-historical method.
548 HENRY M. BACHRACH
* * *
In 1959, Rapaport and Gill attempted to delineate the minimal
number of necessary independent points of view required for a
psychoanalytic understanding of mental activity. They concluded that
a specifically psychoanalytic understanding required dynamic,
structural, genetic, economic and adaptive propositions. Surprisingly,
as Shevrin (1984) pointed out, Rapaport did not include
methodological considerations in this analysis and suggested that
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* * *
As much as psychoanalysis has attempted to maintain its position
as an interrelated method of observation, treatment and body of
theory, it remains that it is first and foremost a clinical procedure.
Without patients, there would be nothing to observe and nothing to
develop a theory about. With patients, clinical considerations are first
and foremost. There is a dialectic between the interests of the patients
and the interests of the science. The clinical aim of psychoanalysis
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its zenith and the National Institutes of Mental Health even bestowed
a large grant to the Menninger Foundation to study nature of change
in psychoanalysis and psychotherapy. By the mid-1960’s the gray
areas so carefully discussed at Arden House burgeoned into a
“widened scope” of indications, which, in some quarters left nearly
every form of psychopathology potentially amenable to some form
of “modified” psychoanalysis. Believing that the wish of therapeutic
zeal was blurring the lens of clinical reality, in 1954 Anna Freud had
already called for a narrowing of the scope of indications, in 1971
Tyson and Sandler emphasized the distinction between the indications
for psychoanalysis and the suitability of the patient for the psycho-
analytic undertaking, and in 1975 Rangell spoke of a need to recognize
an “optimum scope” for psychoanalytic therapy, and within this scope
to “use psychoanalysis for what it can do” (p. 96). At issue was the
difference between the analyst’s ability to understand the patient and
the patient’s ability to benefit from that understanding, and that
analyzability was in danger of becoming equated with a simple
concept of treatability. The climate in which psychoanalysis was
evolving continued to change. Formal research was gaining a foothold
in clinical disciplines, alternative treatments were beginning to show
their mettle, and psychoanalytic values came into question. By the
1980’s it was becoming more necessary for psychoanalysis to more
systematically clarify and elucidate its fundamental propositions, to
take cognizance of formal research, and to demonstrate its place in
relation to alternative treatment methods. One consequence was an
effort to more clearly delineate the difference between analyzability
and therapeutic benefit. The meaning of analyzability returned to
the quality of the analysand’s participation in the psychoanalytic
work, though now the contribution of the analyst to the dyadic
interplay became a focus of greater attention. By the 1990’s world
wide communication became commonplace, information and ideas
554 HENRY M. BACHRACH
REFERENCES
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