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Reanalysis1 Exercise in Definition (1968) Contemp. Psychoanal., 4:83-102 Reanalysis1 Alberta B. Szalita, M.D. Not to enlighten one who can be enlightened is to waste a man; to endeavor to enlighten one who cannot be enlightened is to waste words. The intelligent man wastes neither his man nor his words. CONFUCIUS THERE IS HARDLY any vocation in which there is so much coincidence between the person and his work as in our profession. The psychoanalytic tenets must become part of one's personality rather than an external set of theoretical conjectures. What the analyst is or wants to be has more to do with the way he works than the theoretical frame he uses. And since the work is accomplished in discrete segments of direct, immediate experience and response, this is very difficult if not impossible to reproduce in an abstract form, suitable for generalization. Psychoanalysis is an aristocratic method. It is meant for few by few. It is a method of self-investigation, self-correction, self-redirection, and reorganization, which require disciplined thought and serious commitment. The democratization and widespread application of this method, irrespective of the qualifications of the recipients as well as the practitioners, have brought many disappointments to both sides. The institutionalization of the method has taken away some of the freshness it had in its earlier stages and rigidified it and put it into harness—an added burden toindividual initiative. Yet psychoanalysis remains the method of choice in acquisition of self-knowledge and alleviation of unnecessary mental suffering for suitable patients. For many of us have felt the immense benefits in our development and increased knowledge in the ways of man. I am one of those who has never lost sight of what psychoanalysis has done for me in making my life easier, as well as providing me with a method of investigation and understanding of human behavior. But the indiscriminate use of this method has, at times, done injustice to psychoanalysis. All this becomes evident, even exaggerated, as one considers the problem of the "repeaters" who persistently seek further treatment in spite of disappointments. Of course, this paper does not consider a perhaps larger number of patients who derived as much as they wanted in their first analysis, and therefore never returned to the analyst. Thus, they do not come to our attention. Exercise in Definition First, what is reanalysis? The word is currently used to describe any attempt to work with a new analyst, irrespective of what type of treatment the patient received before or is currently engaged in. With all of the reservations about definitions in our field, I shall attempt to give my own. I would suggest that the term "reanalysis" be used literally; it must be preceded by a dynamic analytic experience, not by ritual alone. The patient must be capable of dealing with conscious and unconscious forces, with transference and resistance and the analytic method of introspection. In short, he evidences a measure of integration of the analytic method and technique. Those who come to reanalysis are expected to have given the first analysis a running trial in the ordinary way of life. Furthermore, after the first analysis, they should be able to make emotional reinvestments in real people, integrate the benefits of the first analysis with a positive effect on their personal lives, and show some evidence that the original inadequacies that were prominent during the first analysis have disappeared. Sufficient time should have elapsed between analysis and reanalysis so as to allow for stabilization of the original accomplishments and for testing them in everyday life. 1From a paper delivered before the Association for Psychoanalytic Medicine, New York City, November 14, 1967. The subject was suggested by the Program Committee Chairman, Dr. Ruth Easser, to whom I extend my appreciation. Thinking about it for a year was a very rewarding experience. 3Cf., for example, Kramer. 8 - Can one call each and every attempt analysis? Obviously not. It might be necessary then to distinguish between this term and other terms used widely, such as "continuation, " "interruption, " "intermittent analysis" (Mahler), "second analysis" (Wagner), and to decide whether, in spite of overlapping, there is enough difference to warrant the use of "reanalysis." In a 1959 paper, Maria Kramer 8 speaks of the autoanalytic function; according to her, it develops during analysis: I have made the assumption that the capacity to integrate unconscious conflicts in the form of insight can become an independent ego function, which for purposes of this communication, I shall call auto-analytic. I assume this function to be initiated by psychoanalytic therapy … I think that the capacity for introspection is a prerequisite for a successful analysis, and some measure of it needs to be present at the start. Her point, however, is well taken for this is sometimes the major problem in analytic work: how to get the patient to use insight, to ask pertinent questions; how to kindle this capacity and interest in scrutinizing his behavior; how to induce the patient to examine his intention, notice the form his communication takes, follow the content, observe the effect, register the feedback, and correct or modify when necessary. This faculty is clearly absent or markedly thwarted in the obsessive, paranoid, and melancholic groups. And these are the patients who are most likely to seek additional treatment. I mention Maria Kramer's observations because I think the presence or absence of what she calls the "autoanalytic function" may be helpful in distinguishing whether or not the subsequent attempts are to be called "reanalysis." How should we distinguish between "continuation of analysis" and "reanalysis"? It is not always easy, and there may be overlapping. For example, analysis may have been interrupted by force of circumstances, death of an analyst, or moving to a different city or country. These are realistic reasons why a patient may seek to continue analysis; this should not be called reanalysis, I think, even though a certain type of reanalysis may or will take place. The continuation of analysis may proceed immediately or after a number of years. Of course, short interruptions occurring regularly due to vacations, illnesses and the like are not taken into account. It may still fall within the category of continuation of analysis even when the interruption is due to a "divorce, " to use Wagner's analogy of second analysis to second marriage, or a third to athird marriage. 14 Another question: Does a second or third attempt at analysis rate the name "continuation of analysis"? There are some cases in which analysis did not really occur in the first place. I have come to the conclusion that only too often the first or subsequent attempts can not be called analysis, though the patient may have worked with an outstanding person in the field. This is not to say that the previous work was useless. In a number of cases, the patients praised their former analysts for concrete help, such as in graduating from a university, finishing a doctoral dissertation, or overcoming a depression. However, the patients were unable to explain exactly what helped them or what happened during the treatment. In some cases, they were encouraged by their former analysts to seek more therapy but with a different therapist. In these cases, the former analysts termed the treatment they had given "psychotherapy." Since it was difficult to spot any real acquaintanceship with the analytic method for this group, it might be more appropriate to look on their previous experience as a preparation for analytic work and to call their second attempt their first analysis. There is very little literature directly related to this topic. In a broader sense, however, the entire accumulated analytic experience over the years has a bearing on the problem of reanalysis. Valuable comments may be found dispersed in a great many works of many contributors, among them Freud, Greenacre, Greenson, Karush, Kris, and Winnicott. Wagner's very readable paper, "The Second Analysis" 14 has a direct bearing on this discussion. The others are Maria Kramer's, 8 which I have already mentioned, and Pfefer's "The Meaning of the Analyst after Analysis." 10 Freud's paper, "Analysis Terminable and Interminable" remains a treasure for stimulating ideas. I found it expedient to take Wagner's view, since he conveniently points out that the patient seeking a second analysis presents a variety of diagnostic and technical problems, concerning which the psychoanalytic literature offers no specific guidance. No model technique for a second analysis has been suggested. It seems that we have not learned to translate the analytic experience into a communicable form because the mechanisms of change are unknown. We actually deal with consequences, not causes. It is the complexity of the task that frightens us away more than anything else. Wagner, too, fails to supply a model for reanalysis, and I'm not really sure that one is needed. Perhaps what we need more is to revise our model for analysis. Among the various interesting items contained in Wagner's paper, I want to pursue one at length. He states that there is "a curious disinclination on the part of analysts to relate their experience with patients who leave their colleagues." We show the same "curious disinclination" to report our experiences with our own patients, let alone that of others, even though we are all in the same boat—all of us have had our successes and failures. I think that some of this reluctance can be explained by the relatively low self-esteem we hold for ourselves in our profession. This is particularly true of the noxious tendency to interpret compulsively and always with a negative slant on things.
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