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A Basic Theory of NeuropsychoanalysisA Cursing Brain?A Dream of Undying FameA Map of the MindAfter LacanAgainst AdaptationAgainst FreudAn Anatomy of AddictionAnalytic FreudAndré Green at the Squiggle FoundationAnger, Madness, and the DaimonicAnna FreudAnna Freud: A BiographyApproaching PsychoanalysisAttachment and PsychoanalysisBadiouBecoming a SubjectBefore ForgivingBerlin PsychoanalyticBetween Emotion and CognitionBeyond GenderBeyond SexualityBeyond the Pleasure PrincipleBiology of FreedomBoundaries and Boundary Violations in PsychoanalysisBuilding on BionCare of the PsycheCarl JungCassandra's DaughterCherishmentConfusion of TonguesContemporary Psychoanalysis and the Legacy of the Third ReichCrucial Choices, Crucial ChangesCulture and Conflict in Child and Adolescent Mental HealthDarwin's WormsDesert Islands and Other Texts (1953-1974)Dispatches from the Freud WarsDoes the Woman Exist?Doing Psychoanalysis in TehranDreaming and Other Involuntary MentationDreaming by the BookEnergy Psychology InteractiveEqualsErrant SelvesEthics and the Discovery of the UnconsciousEthics Case Book of the American Psychoanalytic AssociationFairbairn's Object Relations Theory in the Clinical SettingFed with Tears -- Poisoned with MilkFeminism and Its DiscontentsForms of Intersubjectivity in Infant Reasearch and Adult TreatmentFour Lessons of PsychoanalysisFratricide in the Holy LandFreudFreudFreudFreudFreudFreudFreud and the Question of PseudoscienceFreud As PhilosopherFreud at 150Freud's AnswerFreud's WizardFreud, the Reluctant PhilosopherFrom Classical to Contemporary PsychoanalysisFundamentals of Psychoanalytic TechniqueGenes on the CouchGoing SaneHans BellmerHappiness, Death, and the Remainder of LifeHate and Love in Psychoanalytical InstitutionsHatred and ForgivenessHealing the Soul in the Age of the BrainHeinz KohutHeinz KohutHidden MindsHistory of ShitHope and Dread in PsychoanalysisImagination and Its PathologiesImagine There's No WomanIn Freud's TracksIn SessionIn the Floyd ArchivesIntimaciesIntimate RevoltIrrationalityIs Oedipus Online?Jacques LacanJacques Lacan and the Freudian Practice of PsychoanalysisJung and the Making of Modern PsychologyJung Stripped BareKilling FreudLacanLacanLacanLacan and Contemporary FilmLacan at the SceneLacan For BeginnersLacan in AmericaLacan TodayLacan's Seminar on AnxietyLawLearning from Our MistakesLove's ExecutionerMad Men and MedusasMale Female EmailMelanie KleinMemoirs of My Nervous IllnessMental SlaveryMind to MindMixing MindsMoral StealthMourning and ModernityMovies and the MindMurder in ByzantiumNew Studies of Old VillainsNocturnesNoir AnxietyOn Being Normal and Other DisordersOn BeliefOn IncestOn Not Being Able to SleepOn the Freud WatchOn the Way HomeOpen MindedOpera's Second DeathOvercoming Destructive Beliefs, Feelings, and BehaviorsPhenomology & Lacan on Schizophrenia, After the Decade of the BrainPhilosophical Counselling and the UnconsciousPractical Psychoanalysis for Therapists and PatientsPsychiatry, Psychoanalysis, And The New Biology Of MindPsychoanalysisPsychoanalysis and Narrative MedicinePsychoanalysis and NeurosciencePsychoanalysis and the Philosophy of SciencePsychoanalysis as Biological SciencePsychoanalysis at the MarginsPsychoanalysis at the MarginsPsychoanalysis in a New LightPsychoanalysis in FocusPsychology, Psychotherapy, Psychoanalysis, and the Politics of Human RelationshipsPsychotherapy As PraxisPutnam CampQuestions for FreudRe-Inventing the SymptomReading Seminar XXReinventing the SoulRelational Theory and the Practice of PsychotherapyRelationalityRepressed SpacesRevolt, She SaidSecrets of the SoulSerious ShoppingSex on the CouchSexuationSigmund FreudSoul Murder RevisitedSpectral EvidenceSpirit, Mind, and BrainStrangers to OurselvesSubjective Experience and the Logic of the OtherSubjectivity and OthernessSubstance Abuse As SymptomSurrealist Painters and PoetsTaboo SubjectsTalk is Not EnoughThe Arabic FreudThe Art of the SubjectThe Brain and the Inner WorldThe Brain, the Mind and the SelfThe Cambridge Companion to LacanThe Challenge for Psychoanalysis and PsychotherapyThe Clinical LacanThe Colonization Of Psychic SpaceThe Condition of MadnessThe Couch and the TreeThe Cruelty of DepressionThe Dissociative Mind in PsychoanalysisThe Dreams of InterpretationThe Examined LifeThe Fall Of An IconThe Freud EncyclopediaThe Freud FilesThe Freud WarsThe Fright of Real TearsThe Future of PsychoanalysisThe Gift of TherapyThe Heart & Soul of ChangeThe Knotted SubjectThe Last Good FreudianThe Letters of Sigmund Freud and Otto RankThe Mind According to ShakespeareThe Mystery of PersonalityThe Mythological UnconsciousThe Neuropsychology of the UnconsciousThe New PsychoanalysisThe Power of FeelingsThe Psychoanalytic MovementThe Psychoanalytic MysticThe Psychoanalytic Study of the ChildThe Psychoanalytic Study of the ChildThe Psychodynamics of Gender and Gender RoleThe Puppet and the DwarfThe Real World Guide to Psychotherapy PracticeThe Revolt of the PrimitiveThe Seminar of Moustafa SafouanThe Sense and Non-Sense of RevoltThe Shortest ShadowThe Social History of the UnconsciousThe Surface EffectThe Symmetry of GodThe Tragedy of the SelfThe Trainings of the PsychoanalystThe UnsayableThe World of PerversionTherapeutic ActionTherapy's DelusionsThis Incredible Need to BelieveThoughts Without A ThinkerTo Redeem One Person Is to Redeem the WorldTrauma and Human ExistenceTraumatizing TheoryUmbr(a)Unconscious knowing and other essays in psycho-philosophical analysisUnderstanding Dissidence and Controversy in the History of PsychoanalysisUnderstanding PsychoanalysisUnfree AssociationsWalking HeadsWay Beyond FreudWhat Does a Woman Want?What Freud Really MeantWhen the Body SpeaksWhere Do We Fall When We Fall in Love?Whose Freud?Why Psychoanalysis?Wilhelm ReichWinnicottWinnicott On the ChildWisdom Won from IllnessWittgenstein on Freud and FrazerWittgenstein Reads FreudWorld, Affectivity, TraumaZizek
Often psychoanalytic theory, as interesting as one may find it, seems to be unable to prove itself to be effective therapy. It is true that therapy is difficult to measure and patients demand privacy, but the wealth of psychoanalytic books which are devoid of contemporary examples (and instead rely solely upon Freud's rich but outdated case studies) makes one wonder if psychoanalysis is its own worst enemy. Since therapeutic practice is under greater demands to prove its value to insurance providers with ever-tighter belts (many HMOs provide little to no allowance for therapy), psychoanalysis seems destined to end up as something of arcane interest to academics and absent from its therapeutic birthplace.
Errant Selves: A Casebook of Misbehavior is a counter-example to the reification of psychoanalysis. The book, edited by Chicago psychoanalyst Arnold Goldberg, is a timely and fascinating collection of case studies of contemporary patients undergoing psychoanalytic treatment. The majority of the book describes eight case studies by various psychoanalysts. Each case study is written by the analyst and followed by a discussion in the group of the case. The setting in which the various analysts come together to discuss their patients is a worthwhile model to follow since it provides a place where the therapists can achieve a more objective view of their own behavior.
The first study in the book "The Case of John Alter: To Catch a Thief or Two" describes a lawyer who suffers from a variety of symptoms. The most interesting aspect of this case is the clear articulation of the therapist's own difficulty in properly approaching Mr. Alter's request to sign off on disability payments. Although John Alter has ceased to practice corporate law, he still makes a good living in law and thus is not truly disabled from his career. The therapist, until later reflection, does not realize what a great role his ambivalent feelings about the insurance payments ends up playing in the therapy. The discussion that follows the case study begins, "This case shows that an analyst functioning with an unrecognized vertical split in his psyche cannot hope to heal a similar split in a patient." (17) The case book presents not only the contemporary problems (obtaining insurance payments) but also the importance of the therapist's own feelings toward the therapy.
Psychoanalysis is not for all patients. In many of the case studies the patients were first undergoing psychotherapy before being recommended for analysis. Not only does psychoanalysis require a great time commitment, but it also requires high functioning individuals who don't need quick results. Psychoanalysis entails a long-term and intensive interaction between patient and therapist (four times a week is usually required). The therapist is not able to know instantaneously what ails the patient and what needs to be done. The work involves a constant reassessment of the goals and status of the patient. Thus, although the therapist is able to achieve a greater distance from the therapy, nonetheless his/her own attitude toward the patient is also dynamic. Mr. Alter's therapist overestimated his ability to not allow his resistance to signing off on disability papers to affect the treatment. All ambivalent feelings in the therapist must be addressed for the therapy to work.
The case study of Peter Stone ("A Case of Compulsive Masturbation") notes that the therapist had great ambitions to "show up" the famous therapist whom Mr. Stone had been seeing before beginning therapy with her. It also notes that she was under pressure to finish her training (and thus terminate the treatment). However, despite these comments that might seem to threaten the legitimacy of the "objective" analyst, they further bolster confidence in psychoanalysis' ability to effectively treat patients by emphasizing the psychoanalyst's constant self-assessment.
My favorite analyses were of Rashid ("Purloined Letters: The Psychoanalysis of a Man Who Stole Books") and Bert ("A Case of Infidelity"). Rashid is a graduate student stuck in writers block with a compulsion to steal books. Rashid benefits greatly from the analysis, even though it is prematurely terminated. He is able to make steps towards finishing his work as well as getting more control over his kleptomania. One comes away from his case feeling that he is better equipped to handle his depressions because his acknowledgment about his own internal split is not only intellectual but also reflected in his changed behavior.
Bert is a sixty year old man who has lost his wife and girlfriend to his infidelities, has a poor relationship with his children, and, due to his lack of earlier control over his finances, still needs to work long hours. Yet, nonetheless, his artistic photography (his sublimation) and his sense of humor remain and the phoniness that characterized the early sessions evaporates. The therapist notes the talent in his photographic work and the stronger sense of self "..[t]he con-artist aspect is gone." (72) Bert's case represents how analysis rarely provides a package happy solution to all of life's problems, but instead creates individuals who are able to find ways in which to channel their energy usefully instead of allowing it to divide and destroy them.
In Errant Selves, not all of the case studies end in success. Two of the patients, Rashid and Kool ("The Psychoanalysis of a Transvestite") move and thus have to terminate analysis before the analyst feels the time is proper. Kool is less successful than Rashid. Although he is often confident and happy about his "beautiful woman" side, his anxiety, depression and humiliation demonstrate that he never is able to achieve a true resolution with himself. In regard to his "beautiful woman" side Kool never comes to terms with his desire to be a woman and remain a man "He liked being a man. He wanted to be both [man and woman], so he felt despair." (32) Yet, despite Kool's obvious inability to come to a satisfactory arrangement, he remained throughout the analysis intent on running away from this split which cause him the despair, "Nonetheless it was very difficult for Kool to stay with the idea of sadness. Almost as soon as his thoughts turned to the subject, he began to fixate on sexual matters or else on practical questions of living. He was forever asking me how to do this or that and became quickly enraged when I suggested that he wasn't so much interested in where he might, for example, buy a used computer as he was in escaping painful feelings that he seemed to be on the brink of fully experiencing and sharing." (42) This inability of the therapy (most likely due to its short length) to push Kool to remain in the painful feelings and work through them results in the therapist noting "[t]he analysis began for me with a sense of disquiet and ended with one of failure." (44)
Yet, despite the failure of Kool's case, one comes away from this book with an example of a first class contemporary psychoanalytic casebook, as well as a sense of the legitimacy of psychoanalytic therapy in the contemporary world. The successful cases demonstrate amply that only by working through patterns established in childhood can patients hope to truly end their symptoms (instead of just moving from one problematic outlet to another). The focus on the therapist's own attitude helps to avoid abuses in therapy and brings more of a "peer review" into the clinical setting. These cases are suitable for demonstrating how psychoanalytic therapy can work effectively.
Talia Welsh is a Ph.D. student in Philosophy at the State University of New York at Stony Brook. She is writing a dissertation on Merleau Ponty's psychology.