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Think of it.
When our car breaks down and we take it for repair, we want a mechanic who has a scientific basic knowledge of its parts and internal operations. We also want one who can find our particular problem. We worry if we see that his(her) own vehicle is in disrepair. And if he misperceives our badly-behaving beast and takes a dislike to it, we worry more.
And if the vehicle is our mind, and the service person a mental health specialist,
and we come late and surly for our initial appointment, we want him(her) to realize that he has just witnessed the first sign of its malfunction.
Of course a friendly relationship would be welcome, but that is not our primary desire. With deep and lovely years to spend and miles to go before we end, it's reliable transportation we're after.
So is it impossible to achieve a level of expertise that could help us get it?
Yes, there are differences.
The human mind was not conceived and built by an engineer who could rhyme off its intricacies at will. But scientific clinical studies of its after-creation states could lead to such. Botanists and zoologists have developed testable theories of phenomena that they did not produce.
During his medical training, Dr. Harry M. Anderson was inspired by the apolitical curiosity, courage, and determination of the scientists he encountered, and he carried their example into a career in the psychoanalytic domain. It led him to test the definability of its concepts and the predictive capability of its principles, and methods for doing so during treatments were developed. Some held up to validation procedures while others did not, and a reliable body of theory began to emerge from the work.
As it proved repeatedly accurate in sessions with patients, he applied it in a parallel analysis of self after his training analysis. Then, new research data emerged from several sources to expand its range, and as the roots of some of life's most severe symptoms were reached and dismantled, the goal of providing "complete analyses" became more than possible. It also became apparent that unsuspected artistic creative potentials could be released in self and others; and that theoretically-informed analyses could create extensive ripple effects in families, career situations, marriages, and friendships.
None of his specific research was planned, but retrospective notations revealed that each had followed naturally upon the one before. Initial offerings had energized the curious part of his mind and pulled the rest of it with them.
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FROM AN ART TO A SCIENCE OF PSYCHOANALYSISTHE METAPSYCHOLOGICAL FORMULATION METHOD
By HARRY M. ANDERSON
Trafford PublishingCopyright © 2011 Harry M. Anderson MD D.Psych FRCP
All right reserved.
Chapter OneTHE SYMPTOMS OF THE CLINICAL SITUATION AND THE FRAMEWORK REQUIRED FOR THEIR IDENTIFICATION
"Symptoms" are concrete, objectively-observable phenomena that present, or are presented, in different categories and forms and with everyday regularity in consultation and treatment sessions until an analysis has been successfully completed. Those that appear in spontaneous behavioral terms from the moment the consultee enters the consultative situation are of the greatest formulative importance. Those reported (e.g. phobias) can inform the consultant if he(she) understands their metapsychology, but they do not contain what are called "working surfaces" and the conflicts that underpin them do not become observable and workable until late in the course of any treatment undertaken.
Symptomatic acts (or behaviours) in the broad sense (i.e. not limited to Freud's narrow group of the same name - 1905, p.76-79) are characterized by their non-self-evident, non-functional, non-realistic, non-simple and non-ordinary properties in the contexts in which they appear. They are important because they are indicators of the operative, internal conflicts that are fuelling the consultee's sufferings, and signifiers of the complex metapsychological states that the treatment process addresses.
One main type of behavioral symptom encountered in the clinic is that deriving from a Character Neurosis. That old diagnostic category has recently been replaced by the term "Personality Disorder", but it remains the more suitable of the two.
A "character symptom" is like a "stamp" or "mark" (the Greek etymological origin of the word) on a developing self, imposed by problem caretaker figures that divert the original, unconflicted "real self" from its natural developmental course. The wording emphasizes the fact that such symptoms are always accretions on that self and never parts of its basic shape and function.
The term "personality" (from the Latin, "persona", a mask used by an actor) is more aptly applied to this theory's concept of what will later be called the "social self" - a self organization that suppresses the "real self" to adapt to problem-object standards, avoid danger and be accepted. Its emphasis is thus on a more surface and less fundamental aspect of the symptom concept.
The term "character" also implies a particular, repetitive ("characteristic") pattern to the behaviour of the consultee's collection of conflicted selves, of which the "social self" is but one part. And an on-the-spot "meta" dissection of a character symptom includes much more detail than one that describes only its social-self component.
The second major type of symptom is that of the Symptom Neurosis, an old term used to encompass disorders of the Phobia, Obsessive-Compulsive, Conversion, Dissociation and Neurotic Depression types. The symptoms of this category are distinctly different from those of the character variety. They are always imbedded in co-existing symptoms of the character kind, and they are deeper-lying extensions of them.
In addition to the above two main categories, there are many phenomena in the clinical situation that, by definition, qualify as symptoms, but are not understood as such and sometimes go unrecognized. Transferences are a good example. As is the case with any symptoms, the concrete, objectively-observable signs that identify transferences are surface indicators of underlying metapsychological contents and structure-processes that are not, themselves, represented in the consultee's presented material.
THE IDENTIFICATION OF SYMPTOMS
A SCIENTIFICALLY-DEVELOPED CONCEPTUAL FRAMEWORK OF OBJECTIVESAND METHODS IS ESSENTIAL
Some symptomatic behaviours in clinical sessions are what can be called Technically-Significant because they: (a) incorporate and negatively transform the Essential Elements of the Clinical Process (to be explained later); (b) are not observed by the consultee; (c) need immediate attention. To identify them, a concept of how the situation would appear when no such symptoms are present is required. And to develop one, the goals and means of the analytic enterprise must be studied in detail, clearly determined and explicitly defined. Then the defined elements become a collection of "Reference Points" of normal process against which such symptoms stand out in relief.
The collection can be described in general and specific terms as follows.
A: General features
1. The consultee has come to consultation to be served.
2. The consultant has come primarily to serve and secondarily to be paid.
3. No commitment is necessary.
4. The consultee is seeking help to dismantle significantly disturbing symptoms that belong in the analytic domain.
5. The symptoms are accretions on his(her) engaging self and not the person himself.
6. A psychoanalytic treatment is a self analysis driven by the consultee's goals, and carried out by him with assistance.
7. The assistance is provided in the form of formulative information and guidance by a theoretically-knowledgeable and skilled consultant if, as, and when, required.
8. The background social situation in which the analytic work takes place is one in which there is mutual respect and esteem and both parties enjoy the normal pleasures that accompany a progressive, collaborative effort.
B: Specific process elements
1. Has a defined observational field in which direct verbal communications within sessions are understood to contain the presented material's surface.
2. Relies exclusively on objective perceptions of such.
3. Treats countertransferences and subjective experiences other than those of the conflict-free empathic variety as valued material for self analysis only.
4. Has defined the four essential elements of a successful analytic process (to be described in the next section) and uses them as reference points to determine if they have been transformed by symptom processes.
5. Has established explicit, realistic goals for the consultative phase to be explained at the start of consultation.
6. Has established a realistic consultation format in which such goals can be reached.
7. Has developed a realistic concept of the Free Association procedure to be provided in the form of an instruction on the occasion of the consultee's first need for insession direction.
8. Has developed a treatment-supportive approach to lateness and absence to be explained on the first occasion of the subject becoming pertinent or earlier.
9. Has established treatment-supportive guidelines if fees for lateness and missed sessions are to be considered, and discusses them in the first consultative session.
THE PROCESS PRINCIPLES IN DETAIL
Primacy of focus on direct verbal communications:
The conflict material in non-verbal symptomatic behaviours (e.g. greetings and Freudian-type symptomatic behaviours - 1905, p.76-79) lies several layers deep, and it is usually inaccessible to spontaneous observation and exploration by the consultee's observing self. But whether noted by that self or not, the working surface that is the focus of a day's effort is in a symptom imbedded in a direct, intended, verbal expression to the consultant after a session has formally begun. One can physically engage in an action directed at another without self awareness, but one cannot make an intended statement to that person without the possibility of self observation if one is not in a dissociated condition.
Slips of the tongue are not "intended communications" and are therefore excluded from this category. It is also usual for them to go unnoticed by the observing self for a very long time.
Exclusive reliance on objective perceptions:
A consultee/analysand's "symptomatic behaviours" (as above described) are the surface presentations (i.e. "symptoms") of underlying, non-directly-presenting conflictual states. They are objectively observable phenomenological facts, and products of the suffering self organizations that are the subject of the analytic duo's purposeful interest. And to apply the scientific method in pursuit of the clinical situation's purpose, one must start with a description of them.
Countertransferences and subjective experiences:
Countertransferences in the consultant are "transferences", that is, projections from still-problematic internal objects with which the consultant's deeper, not-yet analyzed, self organizations are still in conflict. If a capable, self analytic method is systematically applied, they become opportunities to extend the range of a training or personal analysis, carry out original researches, and expand the reach of existing theories. A thorough-going eradication of them at root levels also frees the clinician's empathy in areas of consultee suffering that would otherwise be closed to that possibility. And an unrestricted, wide-ranging empathic capability in him(her) is an essential background element if an ultimately successful analytic process is to take place.
The four Essential Elements of the Analytic Process:
Symptomatic behaviours in the form of transferences begin to attach to, incorporate, and transform, the elements of the analytic process at the start of consultation without the consultee's awareness. They then continue to do so until they are identified and dismantled by him(her) with the necessary technical assistance. If the consultant and consultee are aware of the places at which such attachments are made, they become more enabled to observe them by signs.
The points of attachment are:
1. The act of coming to sessions (there is one realistic reason to come and two that are symptomatic - to be explained)
2. Responses to a treatment-supportive lateness/absence instruction if applicable
3. Responses to a scientifically-developed free association instruction
4. Responses to the consultant's input (including his/her listening with interest on the consultee's behalf)
Realistic consultative goals explained at the start, and a consultation format that supports their accomplishment:
The consultee requires explicit information that will enable him(her) to proceed into the consultation phase of what may become an analytic treatment with a realistic understanding of purpose and method. Even if he is familiar with psychoanalysis, and even if he is a practising analyst seeking a second analysis, that information is necessary. Thus the consultant must explain what the consultation is meant to accomplish and how it is to carry out its task before the work is started.
It is a little-known, but demonstrable clinical truth, that very technically-significant transferences operate and become identifiable by signs in the first moments of all analytic consultations. It is also true that, in spite of what the consultee has learned about psychoanalysis, he is never in possession of the type of scientific understanding that would allow him to identify and address them. Nor does he know enough, or anything, about how a scientifically-developed analytic process works before having had the opportunity of experiencing one. And, until he has acquired such, neither he nor the consultant can know that the "psychoanalysis" he requested is what he is going to get and want.
These considerations then make it important for:
A. the consultant to have conceived of a consultative framework in which he can introduce, initiate and carry out the immediately-essential transference work and explain how the process works as it progresses.
B. the consultee to have time to experience and learn the process while observing its effects so that a sensible decision about continuing or otherwise can eventually be made.
And, because such goals cannot be accomplished in one fifty-minute session, what this theory has called an Extended Consultation is in order. That is, several sessions of reasonable length (80 minutes, if possible) are required. And as the first meeting begins, the consultee needs to be informed that:
a) he(she) and the consultant will be trying to get some beginning understanding of his symptoms;
b) there will be enough sessions to accomplish the task;
c) some actual analytic work will be done in progress;
d) the consultant will explain how it is carried out as it proceeds;
e) he (the consultee) will eventually be in a position to know if the treatment modality is for him;
f) he will also be able to know if he wishes to proceed with the present consultant (or someone else).
For example, after initial greetings, the M.F. analyst would explain the following - not word for word as in a manual, but from knowledge of the basic information that the situation requires:
"Well, what we'll want to do over the next little while is to take a look at the problems you mentioned on the phone and see if we can begin to get a line on them. We'll do some analysis so that you can get familiar with how we work, and I'll explain things as we go. Then, in time, you'll be in a position to know if it's what you want, and, if so, if you want to continue with me."
A realistic, explicitly-stated concept of the Free Association procedure:
It is an undeniable fact of clinical observation that no consultee who comes to consultation, or analysand who continues afterwards, can "free associate". Barriers that stand in the way are insurmountable for a very long time, and they remain in place until a great deal of effort with material that is not of a free-associative type is carried out.
In a realistically conceived free-association instruction there are three points at which the obstacles arise: (I) when the consultee is attempting to allow associations to come to mind; (2) when he(she) is trying to fill the consultant in with something he has observed; (3) when he is trying to say something that has come to mind to say to him(her). He therefore needs to know that he is to "try" to let come what wants to come, "try" to fill the consultant in on something observed, or "try" to say what is to be said, and flag any difficulties encountered at any point for mutual study.
There are two other elements that are essential to a realistic free association instruction.
The principle is for the consultee's benefit, not the consultant's. The technique is the most useful thing that the consultee can do to contribute to the work that both parties are going to do on his behalf. And continuing in that vein, the main purpose of the first part is for the consultee to get access to the content of what is at the periphery of his own consciousness and take interest in what he finds there. "Talking", though often implied to be a primary part of the procedure (e.g. "the talking cure") is not that at all. It is simply a vehicle for conveying the consultee's findings, so that the consultant can follow them and assist with the self-discovery process when required.
This theory's version of what it calls the Free Association Principle is offered early in consultation and at a moment when the consultee needs the information it provides. For example, he (the consultee) might say,
"I'm not sure where to go from here",
at which point the consultant might give an abbreviated form of it and explain that
"the thing to do is to see what wants to come to mind next"
and elaborate the rest of it as the work proceeds.
To facilitate its use as a "reference point", the complete instruction must eventually be provided, and the one that this method uses is expressed as follows:
"We have two principles that are basic to our work. One we call the Free Association Principle (FAP), and it states:
'The most useful thing you can do to help us with our mutual effort on your behalf is to try to let whatever wants to come to mind come, take interest in what you discover, and try filling me in on what you find, or if it's something to say to me, try saying it. And if there is any difficulty at any point, let us know and we'll look at it. Another way of thinking about it is to try to let yourself be and see what it's like.'" (Continues...)
Excerpted from FROM AN ART TO A SCIENCE OF PSYCHOANALYSIS by HARRY M. ANDERSON Copyright © 2011 by Harry M. Anderson MD D.Psych FRCP. Excerpted by permission of Trafford Publishing. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
PART I: SYMPTOMS AT THE START OF CONSULTATION AND THE TOOLS NEEDED FOR THEIR FORMULATION....................7
CHAPTER 1 THE SYMPTOMS OF THE CLINICAL SITUATION AND THE FRAMEWORK REQUIRED FOR THEIR IDENTIFICATION....................9
CHAPTER 2 THE DEVELOPMENT OF SYMPTOMS....................19
CHAPTER 3 THE SYMPTOM-BEARING MIND AT THE START OF CONSULTATION....................57
CHAPTER 4 CLINICAL RECORDS AND A CODIFICATION SYSTEM....................91
CHAPTER 5 SURFACES AND LAYERS....................111
CHAPTER 6 THE FIRST ROT SYMPTOM....................117
CHAPTER 7 THE "FOLLOW-UP" TECHNIQUE....................127
PART II: THE CONCEPTS AND PRINCIPLES OF PART I ELABORATED....................131
CHAPTER 8 THE SUPEREGO AND THE EGO IDEAL....................133
CHAPTER 9 THE DEFENSES....................157
CHAPTER 10 THE DRIVES: PART 1, IN GENERAL AND "LIBIDO"....................187
CHAPTER 11 THE DRIVES: PART 2, THE AGGRESSIVE DRIVE....................195
CHAPTER 12 TRANSFERENCE: PART 1, THE SINGLE TRANSFERENCE....................291
CHAPTER 13 TRANSFERENCE: PART 2, THE MULTIPLE TRANSFERENCE THEORY....................305
CHAPTER 14 THE SYMPTOMS OF THE "BORDERLINE PERSONALITY DISORDER" AND THE MULTIPLE TRANSFERENCE THEORY....................373
CHAPTER 15 THE CURE OF SYMPTOMS BY THE M.F. METHOD....................383
CHAPTER 16 COURAGE, HEROISM AND RESCUE IN THE PRACTICE OF PSYCHOANALYSIS....................441
PART III: OTHER APPLICATIONS OF THE M.F. METHOD....................449
CHAPTER 17 SELF ANALYSIS....................451
CHAPTER 18 CLINICAL RESEARCH....................463
CHAPTER 19 UNDERSTANDING AND COUNTERACTING DESTRUCTIVE AGGRESSION IN THE WORLD AT LARGE ROBBERY, RAPE, MURDER, TERRORISM, WAR, ETC....................495
CHAPTER 20 THE UNCONSCIOUS SOURCES OF ART....................509
CHAPTER 21 M.F. RESEARCH AND THE FUTURE....................539
THE THEORETICAL AND TECHNICAL TERMS USED IN THIS BOOK....................543
PERMISSIONS, QUOTATIONS, REFERENCES....................551