ELEVENTH AAPDP/OPIFER JOINT MEETING ENDINGS IN PSYCHOANALYTIC PSYCHOTHERAPY: HOW, WHEN AND WHY IN THE FOOTSTEPS OF SILVANO ARIETI Florence, October 17-18, 2009 SELF-ANALYSIS AS AN APPROPRIATE ENDING Marco Bacciagaluppi, M.D.1 Introduction In this paper my guiding paradigm is Bowlby’s attachment theory, according to which the basic pattern of a secure base from which to explore (Bowlby, 1988) is a product of biological evolution which we share with mammals and birds. This pattern was selected in the course of evolution because the infant’s attachment to its mother had survival value and was the prerequisite for the infant’s later independence. Bowlby points out that this pattern is not one phase in a fixed sequence of developmental stages. Attachment needs resurface in later adult relationships. It is therefore legitimate to apply this paradigm to the therapeutic relationship. It can be expected that secure attachment, developing progressively in a patient, leads to exploration, namely to temporary separation. At first the patient will need to return often to the therapist. As therapy proceeds, the patient’s periods of exploration will become increasingly long and will include the establishment of alternative relationships. This is a behavioral description. The process is also accompanied by internal modifications. The patient’s initially unfavorable models of self and other will be modified by the corrective experience of relationship with the therapist. In this view, the ending of therapy is a gradual process which is best left to the patient’s spontaneity. It can, however, be encouraged by indicating to the patient the possibility of utilizing the instruments of therapy on her/his own, namely by carrying out self-analysis. Literature on self-analysis 1 Fellow, AAPDP; Founding President, OPIFER; Member, WPA Section on Psychotherapy. This paper was presented at the Eleventh AAPDP/OPIFER Joint Meeting, Florence, Italy, October 17-18, 2009- 1 The literature on self-analysis is very limited. The first example of this procedure, as we all know, was Freud’s self-analysis, which he carried out in the summer and autumn of 1897. In this work he applied to himself, and especially to his dreams, the technique he had previously worked out and applied to his hysterical patients. Free associations were the starting point of this technique, as already indicated in the “Preliminary Communication” of 1893, which was included in the 1895 Studies in Hysteria (Breuer and Freud, 1895, p. 9). The public outcome of this work, of course, is the book on The Interpretation of Dreams (Freud, 1900). Freud also privately commented on his self-analysis in his letters to Fliess. I had a look at them in preparing this paper. I was struck in particular by his letter of October 15, 1897. Here he is in mid-stream between acknowledging the reality of childhood traumatic events and denying that reality in favor of drives. He is already working on the idea of the Oedipus complex, but at the same time describes what Bowlby calls a “real-life event”, namely an episode of acute separation anxiety. Here is the quotation from the SE: “My mother was nowhere to be found: I was screaming my head off” (Freud, 1897). This is a typical real-life, traumatic event for a small child. In the SE translation I thought I detected a slightly sarcastic tone, which would show a detachment on Freud’s part from his childhood self. So I decided to check with the German original (Freud, 1986, p. 292). Here I found that Freud’s tone was perfectly serious. Speaking in the present tense, he says: “My mother is not to be found, I howl in despair” (Die Mutter is nicht zu finden, ich heule wie verzweifelt). The SE translation is generally accurate, but in case of doubt one should always refer to the German original. The subject of self-analysis was later neglected. It was probably felt that this was the only course open to Freud, and that self-analysis was then superseded by the standard analytic procedure, in which analysis became a two-person situation. Maybe mainstream analysts also stood in awe of an allegedly unique achievement of Freud’s. The only exceptions to this neglect are Karen Horney and Erich Fromm, both representatives of the relational alternative to mainstream psychoanalysis. They were therefore not detained by reverential awe. In 1942 Horney devoted a whole book to the subject, titled Self-Analysis (Horney, 1942). At the outset she anticipates Fromm’s radical aims for psychoanalysis. More accurately, since at one time she and Fromm were very close, some of their concepts were probably worked out together. According to Horney, analysis should not only have the therapeutic aim of the removal of symptoms, of gaining“freedom from” (p. 21), but should also aim at developing one’s best potentialities, “freedom to”. Writing in 1942, Horney is here echoing President Roosevelt’s formulations of freedom. Fromm (1941, pp. 33-35) also uses these terms. In stating the radical aim of analysis, Horney also anticipates concepts which Winnicott (1989) would develop in Britain. She writes: “The more the phony self evaporates, the more the real self becomes invested with interest” (p. 22). This book is admirable in many ways, and is required reading for anyone interested in self-analysis. However, it mainly addresses the very difficult procedure of self-analysis from the start, since Horney is 2 concerned with the wider application of psychoanalysis through self-analysis (p. 11). As I shall state, my concern here is more limited. Fromm took up the subject of self-analysis at various points in his published works, for instance in a very clear and concise statement which appeared in 1981, after his death in 1980 (Fromm, 1981). When he came back to Europe, after many years in the United States and in Mexico, Fromm started writing in German again for some radio lectures. This is from the English translation of one of them: “Once a patient has learned enough to make use of the tools himself, he should begin analyzing himself. And that is a lifelong task that we carry on until the day we die”. In his posthumous works Fromm wrote more at length on self-analysis. There is a long chapter on the subject which was omitted from To Have or to Be? (Fromm, 1992). Here, Fromm sees the trans-therapeutic goal of analysis and self-analysis as the attainment “of being rather than having” (p. 64). He thinks it is preferable for self-analysis to be preceded by “analytic work with a competent analyst” (p. 66). He says that “an analysis aimed at teaching self-analysis” (p. 67) need not last very long. Further, in this work the analyst should be active and confrontational (ibid.). Fromm, like Horney, also considers the possibilityof self-analysis from the start (pp. 68-69). When discussing the methods of self-analysis Fromm uses the term “to feel around” (p. 70) rather than “to think”, in order to avoid the danger of what he calls “cerebralization” (p. 62). I find this is very sound advice, and “to feel around” an excellent expression. Finally, on p. 81, Fromm also mentions Horney’s contribution, although briefly. In this unpublished chapter Fromm sees self-analysis as the primary aim. Instead, in the concise statement I quoted earlier he seems to view it as the outcome of a training or therapeutic analysis, and this is the view I will take in what follows. Self-analysis as the outcome of training analysis Before recommending self-analysis to the patient, the therapist should set a good example by applying this procedure to her/himself. At this point I can anticipate an objection: why bother with self-analysis after a training analysis? There may be several answers. One could be that, for some reason, one’s training analysis may prove in retrospect to be incomplete or inadequate. Some issues may then require to be reexamined. The solution may lie in another analysis, or in self- analysis. Another possibility is that new issues have arisen. Two instances occur to me. (1) If we have undertaken analysis as young adults, it is possible that certain experiences have not yet taken place, such as an important loss, of a parent or a spouse, which typically takes place at a later age. This is one of the real-life events addressed by Bowlby, specifically in the third volume of his trilogy (Bowlby, 1980). If a loss does take place, the available support from friends and relatives, or culturally shaped support, may be sufficient. If, however, the new loss reactivates one endured at an early age, it may be necessary to receive some specific support, either from another individual therapist, or from a group, or, again, from self-analysis. 3 (2) Another possibility is that, since one’s training analysis, some important theoretical development has taken place. One example could be the incorporation of the Post-Traumatic Stress Disorder in the DSM, which took place in 1980 (APA, 1995; I quote from a later edition). The syndrome described in Vietnam veterans proved to be a paradigm for many other traumatic situations, such as catastrophes, incarceration, the taking of hostages, sexual violence, and the psychic, physical and sexual abuse of children. One cannot overestimate the importance of this development. The DSM description reads like a reformulation of the Preliminary Communication. In particular, the “hypnoid states” referred to in the Preliminary Communication (Breuer and Freud, op. cit, p. 12) are better described as “dissociative states” in the DSM (APA, op. cit., p. 436). This development may serve to alert us to the importance of traumatic experience in our own past, which may have been neglected in our analysis, owing to what Judith Herman (Herman, 1992), in her overview of the trauma literature, calls the “episodic amnesia” characterizing the study of psychological trauma.