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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wealth of psychoanalytic books which are devoid of contemporary examples (and instead rely solely upon Freud's rich but outdated case studies) makes one wonder if psychoanalysis is its own worst enemy.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.