“The Psychoanalytic Setting as a Creative Space”1
Peter Loewenberg, Los Angeles2
The psychoanalytic setting is the creative space that governs the analysand’s
and the analyst’s external reality and sets the stage for their mutual explorations of
inner life. The essential characteristics of the psychoanalytic setting are:
1. Time:
The analysand and analyst share a fixed period of 45 or 50 minutes. I allow
an interval of 10 minutes between sessions so we may finish a thought or flesh out
an interpretation. I may give an analysand extra time to compose her/himself. I
also need
to work through and clear my mind from the emotional experience of
immersion in the last patient’s life. The analyst must protect his free floating
attention. Psychoanalysis should be candid about sex, money, and physiological
needs. I allow toilet breaks on my time, not out of the analysand’s session. Ralph
Greenson asked: “If you schedule patients without a time gap, how do you decide
which patient will pay with his time for your toilet activities?”3
But there is to me a compelling reason for a break in time: an assembly line,
back to back, scheduling of patients ignores or minimizes the importance of the
unguarded moments at the opening and closing of a session when many
spontaneous thoughts and feelings are expressed because they are viewed as being
“separate” or “outside” of the hour.
If you plunge immediately to the next
analysand, both the one leaving and the one entering do not have your full analytic
listening presence. As an analyst you try to structure an optimal psychoanalytic
situation where you face each analysand with a fresh, receptive mind, ready to listen
to as many levels as possible.
Psychoanalysis is at three to five times per week frequency to facilitate
intensity of relationship (transference), follow-up, and measured regression. Both
analysand and analyst are expected to give due advance notice about forthcoming
absences, business trips, holidays. The psychoanalytic temporal dimension is to
allow time and emphasize the continuity and dependability of the analytic
relationship.
2. Space and Freedom to Listen for the Unconscious:
Psychoanalytic space is designed to facilitate one of our prime analytic tools -free association of both the analysand and the analyst. The fundamental rule of
psychoanalysis is “that whatever comes into one’s head must be reported without
criticizing it.” (Freud, “The Dynamics of Transference,” 1912, S.E., XII, 107). The
analysand is asked to communicate everything that occurs to him without criticism
or selection “even if he considers it incorrect or irrelevant or nonsensical, and above
all if he finds it disagreeable to let himself think about what has occurred to him.”
(Freud, “Five Lectures on Psycho-Analysis,” Third Lecture, 1910, S.E., XI, 32).
The analyst, in what is a “necessary counterpart” to the work of the
analysand, listens with “evenly suspended attention….He should withhold all
1
For the Psychoanalytic Institute for Eastern Europe (PIEE) Summer School, Odessa, Ukraine, 7-13 June,
2008. The italicized clinical vignettes are strictly confidential and not to be reproduced on any website.
2
Chair, IPA China Committee; Professor of History, University of California, Los Angeles (UCLA);
Training and Supervising Analyst, New Center for Psychoanalysis, Los Angeles, CA. Address: 449
Levering Ave., Los Angeles, CA 90024-1909 USA; Email: PeterL@UCLA.edu
3
Ralph R. Greenson, “The Decline of the Fifty-Minute Hour” (1974), in Explorations in Psychoanalysis
(New York: International Universities Press, 1978), p. 500.
2
conscious influences from his capacity to attend, and give himself over
completely to his ‘unconscious memory.’” (Freud, “Recommendations to
Physicians Practising Psychoanalysis,” 1912, S.E., XII, 111-12).
The analysand and analyst are alone in a quiet, restful, secure, place
supplied by the analyst without outside stimuli or interruptions. No telephone
calls are taken; no service or delivery is received. There will, inevitably, be
“noises off” and distractions or intrusions in the analytic space. When these
occur they are brought into the analytic work and become an element of
analytic understanding. The couch is traditionally used, and generally works,
to help analysands turn to their internal world. I have no problem modifying
the use of the couch if it serves the analytic process. Over 60 years ago Otto
Fenichel was clear about the analytic essentials of the development of
transference and resistance and the fetishistic trimmings:
After an understanding of the therapeutic principles, it is not very
difficult to decide whether or not to call a given treatment
psychoanalysis. Freud once said any treatment can be considered
psychoanalysis that works by undoing resistances and interpreting
transferences, that is, any method that makes the ego face its
pathogenic conflicts in their full emotional value by undoing the
opposing defensive forces, effective as "resistances," through the
interpretation of derivatives and especially of the derivatives
expressed in the transference. This alone is the criterion. Whether
the patient lies down or sits, whether or not certain rituals of
procedure are used does not matter. For psychotics and children as
well as for certain character cases, the "classical" method must be
modified.
That procedure is the best which provides the best
conditions for the analytic task. A "neoclassical procedure," when the
classical one is not possible, remains psychoanalysis. It is meaningless
to distinguish an "orthodox" psychoanalysis from an "unorthodox"
one.4
3. Money:
The analysand pays the analyst for her/his time and expertise, including
payment for missed sessions. I tell my analysands that I need at least 48 hours
notice of an absence or they are responsible for the session. Often an analysand
says they did not feel like coming to a session, but came because they knew they
would be charged for it. An analytic fee is negotiated at the beginning and should be
reasonable to the analysand’s budget and life situation. I have a sliding scale of fees
and give reductions to students, interns, residents, and psychoanalytic candidates. I
have lowered fees to keep the analytic work going when the analysand loses his job
and is unemployed. If there are concessions made to the analysand’s circumstances
in the fee, it is understood that the fee may be revisited if economic circumstances
change.
4. Boundaries:
The analytic frame demarks a separate reality with unique limits, unlike social
life, to provide conditions of safety for both analysand and analyst. The analyst
observes confidentiality; the right of privacy belongs to the analysand. In cases of
training analysis the analyst does not report to the institute on the analysand. The
analysand and analyst have no personal, business, or social relations with each
4
Otto Fenichel, The Psychoanalytic Theory of Neurosis (New York: Norton, 1945), p. 573.
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other. The analyst does not contact third parties regarding the analysand, including
the analysand’s family, attorneys, or state authorities.
5. A Hermeneutic of Suspicion:
Sigmund Freud and psychoanalysis stand with Karl Marx and Friedrich
Nietzsche in exposing and reducing the façades of culture.5 Marx demystified power
structures; Nietzsche exposed the illusions and lies of the sacred; Freud taught us to
doubt consciousness. He invented the science and art of decoding conscious and
unconscious meanings.6
The analyst approaches presenting symptoms differently than other healers -with an attitude of curiosity, sympathy, and suspicion. He knows things are not as
they appear. The manifest is deciphered by listening and interpreting the latent
content of symptoms, symbols and themes.
The analyst is not quick, nor
categorical, in coming to conclusions:
We will begin by examining the material before us. It is not in the
least our business to ‘understand’ a case at once: This is only possible
at a later stage when we have received enough impressions of it. For
the present we will suspend our judgement and give our impartial
attention to everything that there is to observe. (Freud, “Analysis of a
Phobia in a Five Year-old Boy,” 1909, S.E., X, 22-23).
The analyst’s aim is to make the analysand own and become familiar with meanings
that were foreign to her.
6. The State and Psychoanalysis:
The United States and many other jurisdictions have mandated reporting
laws for child abuse and a duty to warn of intended harm (Tarasoff doctrine). The
case of reporting or not reporting to the state is one of the most difficult judgment
calls the clinician must make. It places her in the Nietzschean position of a valuemaker. Some cases -- a terrorist airplane bomber -- is obvious; you do all you can
to stop him. But this is a fantasy hypothetical because suicide bombers and
terrorists do not enter analysis. I decide on a case by case basis with my standards
being protecting the analysand and stopping on-going harm.
Confidential clinical material
The state has many ways to get evidence, so does not need our clinical material and
should stay out of the consulting room for clinical, practical, and ethical reasons. 7
Psychoanalysis and psychoanalytic psychotherapy provide the best chances for long
term character development and working through early traumata. Reporting to state
authorities seriously compromises the therapeutic relationship and the analysis and
opportunity to make inner changes.
5
Paul Ricoeur, Freud and Philosophy: An Essay on Interpretation (New Haven: Yale University Press,
1970), pp. 32-36.
6
Peter Loewenberg, “Psychoanalysis as a Hermeneutic Science,” in Peter Brooks and Alex Woloch,
eds.,Whose Freud? The place of Psychoanalysis in Contemporary Culture (New Haven: Yale University
Press, 2000), pp. 96-115.
Peter Loewenberg, “Psychoanalysis, Sexual morality, and the Clinical Situation,” in Michael S. Roth,
ed., Rediscovering History: Culture, Politics, and the Psyche (Stanford, CA: Stanford University Press,
1994), pp. 61-82, 448-454.
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7. Kinesthetic Setting:
The analysand communicates affectively and the analyst receives and
contains these feelings, trying to empathically process them and not retaliate. The
emphasis is on bringing impulses and desires to consciousness and expressing
feelings through talking rather than acting (S. Freud, “Moses of Michelangelo,”
1914), thus allowing the deep continuities in emotions and life to be seen, felt, and
demonstrated.
The psychoanalytic setting is a secure holding space 8 where the
analysand may bring anxiety which is considered a signal of unconscious threats and
dangers. (S. Freud, “Inhibitions, Symptoms and Anxiety,” 1926) Psychoanalysis is a
space to dosage anxiety and look at unconscious fears and their origins. Medications
are discouraged except temporarily, when the analysand cannot self-reflect. The
analytic stance is to wean the analysand of narcotics and the use of habituating selfmedications to manage anxiety (alcohol, analgesics, “recreational” drugs).
8. Empathy:
Some analysands say the relationship with their analyst is the most reliable
relationship they have ever had.
Confidential clinical material
The analysand is often surprised and moved that the analyst is available and wants
to know her/his pain and what it feels like to face and deal with her/his life situation.
9. The Container and the Contained:
The psychoanalytic setting serves as a creative container,9 by which I mean the
psychoanalytic setting and the analyst are not inert containers, such as a pitcher
which holds water but must be sterile and static, not interacting with the contents.
If the pitcher does interact with the water, you will not drink the water. Rather, the
analytic setting is, if I may use an American metaphor, like an oak lined whiskey
barrel which interacts with the distilled chaotic mash to season and age it, to
detoxify, modify and change it. The barrel is both toasted and charred giving it a
thick charcoal layer on the inside so it can absorb undesired impurities and impart
aromas. The oak barrels for maturing whiskey are not airtight; air enters the cask,
but it also lets the alcohol in the whisky evaporate. During ten years of aging, which
mellows the taste and picks up the wood flavor and color, about one-quarter of the
alcohol is lost to evaporation. The Scots, who use American bourbon barrels, call this
the "Angel's share."
The analytic setting is one of dynamic active containment in which the analyst
regresses with the analysand to her inner space and hears what the analysand
communicates to him on many levels and works these through his unconscious and
conscious associations to put them into a form which first his own ego, then the
analysand’s ego, can integrate. The psychodynamic processes come alive and
internal reality is recognized as also conditioning outside reality. We call this an
analytic interpretation.
8
D.W. Winnicott, The Maturational Processes and the Facilitating Environment (New York: International
Universities Press, 1965), p. 240. See also Playing and Reality, Tavistock, 1971).
9
Wilfred R. Bion, “Learning from Experience,” (1962) in Seven Servants (New York: Jason Aronson,
1977), p. 90.
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10. The Multiple Realities of Psychoanalysis:
Several realities exist concurrently in the psychoanalytic setting:
a.
The transference: the analyst as a significant, sometimes primitive, object
from earlier life with whom repetitions of the past and new perspectives of the self
are experienced.
b.
The countertransference: the analyst’s subjective reactions, emotional
responses and feeling states that are a key to the analysand’s unconscious. 10 This is
why the analyst must himself be analyzed. The analyst needs to carefully monitor
and use his reactions and feelings toward the analysand to try to understand
relational patterns, difficulties in comprehending, defensiveness, and refusal to
investigate material.
c. The working alliance, the therapeutic alliance, and the real relationship:
The psychoanalytic setting is a unique reality contained within the shared frame of
analytic work. The acknowledgment by analysand and analyst that they are in a
joint therapeutic process requiring collaboration, and working together within the
analytic frame. The analysand’s attitudes of trust, compliance, and cooperation are
not exempt from analysis.
The analyst should also be genuine in his desire to
understand, authentic, and compassionate, showing caring and interest in time of
distress.
The analyst should be prepared to admit mistakes and solicit the
analysand’s reactions to his admission.11
11. Attachment and Individuation:
Issues of merger and fusion in tension with autonomy and separateness,
although demonstrably present in the first years of life, are also always present in
adult life.12
Confidential clinical material
Attachment, independence, intimacy and trust are issues for the lifespan that are
experienced and worked through in analysis.
12. Theory and Clinical Practice:
Charles Darwin correctly observed that “without the making of theories I am
convinced there would be no observation.” Nevertheless, clinical theory that is
foregrounded may be an impediment to good psychoanalysis. I urge you to keep
psychoanalytic theory in the background during your clinical work. Listen for the
affect and the “feel” of the conflict and address it. Search with the analysand
through her associations and memories to find the charged life experiences that will
give you the key life metaphors for understanding the analysand’s life. You will
return to this affective metaphor in your work together and it will become an esoteric
“code” or shorthand, understood by no one else, between the two of you as the
analysis proceeds.
Peter Loewenberg, “Subjectivity and Empathy as Guides to Progress in Counselling,” Councellor
(Peshawar: Institute of Educational and Vocational Guidance in Pakistan, 1984), 2-84 (July-December,
1984), 1-15.
11
Ralph R. Greenson, The Technique and Practice of Psychoanalysis, Vol. I (New York: International
Universities Press, 1967), pp. 190-224.
12
John Bowlby, Attachment, Vol. I of Attachment and Loss (London: Tavistock, 1969, 1982). Margaret
S. Mahler, Fred Pine, Anni Bergman, The Psychological Birth of the Human Infant: Symbiosis and
Individuation (New York: Basic Books, 1975). Daniel N. Stern, The Interpersonal World of the Infant: A
View from Psychoanalysis and Developmental Psychology (New York: Basic Books, 1985).
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