terça-feira, 2 de agosto de 2011

Comments on Owen Renik, Elizabeth Bott Spillius

Owen Renik, as usual, presents an admirably brief and forceful statement of his point of view on intersubjectivity in psychoanalysis and I am pleased to have been asked to comment on it.
Renik's approach seems to me to be based on two strands of thinking. The first is that truth is what the thinker thinks it is, or, less tendentiously, although truth may exist independently of the thinker, it can only be known through the subjective experience of the thinker. The second strand is a form of what one might call sensible American pragmatism: put crudely, truth is what works.
My own tacit assumptions are different from Renik's, which makes me cautious about commenting on his work. It also leads to my sometimes having difficulty in following his thought. For example, whenever I read Renik's presentations I repeatedly have an experience of feeling myself pulled up short. I read a sentence, and I think I agree with what it says, and I think that probably other psychoanalysts would agree with it too. It is then followed by a second sentence which Renik evidently thinks follows logically from the first, but I don't agree with the second sentence at all. I then realise that I don't know how the transition occurred. Either there is something wrong with my understanding, or there is some flaw in the logic of the sequence. Whatever the reason, I find myself stopped in my tracks by the experience, and I find it difficult to go on until I've looked at it more closely.
For example, near the beginning of the paper Renik says, 'Insight is something co-created by analyst and patient as much as it is something discovered by analyst and patient. To differentiate co-creation from discovery in clinical psychoanalysis is to establish a specious distinction'. I agree, apart from the slight unfamiliarity of the word 'co-create', with the first sentence. But I don't see how the second sentence follows. To me, 'creating' is not the same as 'discovering'. 'Create' means to bring into being something that was not there before. 'Discovery' means that there is something already there beforehand whose existence has now been recognised, but not created. Freud, for example, made certain observations about patients, including some observations about himself, in which he 'discovered' a certain pattern. He 'created' the term Oedipus complex to describe the pattern. He did not 'create' the behaviours he observed; he did not 'discover' the term.
How did Renik get from the first sentence to the second? I thought it must have something to do with that rather imprecise phrase 'as much as', which I took to mean something like 'can be compared to' in the first sentence, but in the second sentence it had become 'is the same as'. Perhaps, I thought on closer examination, I only agreed with the first part of the first sentence, namely, 'Insight is something co-created by analyst and patient', not with the second part, 'as much as it is something discovered by analyst and patient'. By this time I felt out of my depth in a philosophical inquiry which I am not equipped to conduct. Marcia Cavell (1998), with proper philosophical knowledge and skill, has tackled several aspects of what she calls Renik's assertions about truth being relative to goals and situations. She also asserts that Renik believes in the existence of objective reality more than he acknowledges. By this time I had come to realise that my different basic assumptions were making it difficult for me to follow Renik's thought. I read on.
But then I ran into another sentence that stopped me in my tracks again, though not for quite the same reason. Renik says, 'The famous analogy in which the patient is compared to a naive railway passenger who faithfully describes passing scenery, and the analyst to a knowledgeable railway conductor who determines the train's geographic location, based on the passenger's reports, is no longer sustainable'. I wondered what led Renik to make such important changes in Freud's analogy (Freud, 1913, p. 135). Freud's 'traveller sitting next to the window' has become 'naive' in Renik's version, and Freud's 'someone inside the carriage' has become 'a knowledgeable railway conductor' to Renik.
Renik seems to be arguing with someone - not, I think, with me, though there are issues about which I am sure he disagrees with me and my Kleinian colleagues. But he strongly disagrees with a wrong-headed analyst/conductor who thinks he knows the reality of the patient's psyche and believes that he has a right to dictate his superior understanding to the patient and to judge the patient's analytic progress by the analyst's own psychoanalytic goals. This wrong-headed but powerful analyst sounds like the older generation of ego-psychologists, and it is evident that Renik wants to create an analytic atmosphere of greater liberty and perhaps equality, an aim with which one cannot but sympathise. Perhaps, however, he underestimates the extent to which the wrong-headed train conductors have been won over by the quiet revolution. Or perhaps not. I am not as familiar with American psychoanalysis as he is.
I think, however, that there has been a general change of focus in analysis both in the United States and elsewhere. The analysts of Freud's generation thought that their task was to observe the patient and the patient's involvement in the analyst-patient relationship, the transference. The countertransference, as Renik says, was perceived only as an interference, and he believes that it is quite impossible for the analyst to rid himself of his subjectivity as Freud implies he could (Renik, 1993). In some respects, it seems likely that the changed attitude towards countertransference happened earlier and more extensively in Britain than in the United States, although it was not phrased as a recognition of the analyst's subjectivity. Heimann's 1950 paper in which she said that the analyst's countertransference response could be a useful source of information about the patient has had a considerable impact, and so has Money-Kyrle's 1956 paper 'Normal counter-transference and some of its deviations'. Even Money-Kyrle's title makes clear that he considers countertransference to be 'normal', useful; he does not consider it either possible or useful to try to eradicate it. He makes distinctions, of course, as his title implies, between 'normal' and 'undesirable' countertransference. But by this time it was assumed that the analyst had an effect on the analytic situation that he was studying. Another difference is that the term 'neutral' has never been emphasised in British analysis and I think not in European continental analysis either. The ego-psychological preoccupation with neutrality has always seemed odd to us, as if it were not only an injunction to be impartial but also an endowment of mysterious inscrutability and power to the analyst. So there has been less of a battle in Britain and I think in Europe over getting analysts to recognise their subjectivity and the effects it may have, and perhaps an earlier recognition that the task of the analyst includes observation of himself as well as observation of his patient and of the analyst-patient interaction. Correspondingly, there has perhaps been less initial conformity to analysts and analysis-analysis has never been 'trendy' in Britain-and, subsequently, less indignation about the analyst's knowledge and authority.
Judging from his clinical accounts in other papers (1993, 1995, 1998, 2001), I think Renik thinks, as I do, that it is possible for the analyst to be at least somewhat aware of the way his subjectivity has an impact on the patient and on the analytic relationship, that is, it is to some degree possible for the analyst to observe himself as well as to observe others. Perhaps I take it further than he does, for I think that it is possible for the analyst to be subjectively involved in the analytic interaction but to take at least a partly outside view of it in the same session. This cannot be done at the same moment. I think there is usually a fluctuation in the session between being 'in' and being somewhat 'outside' the interaction. In very heated or overwhelming moments this is sometimes not possible and it is not until the session is over that the analyst may have another additional view to set alongside the feelings and thoughts he experienced in the session.
How does one know whether a constructed insight (interpretation?) is valid? I think this is not immediately apparent, for at least in my experience agreement does not necessarily mean the insight is correct, and disagreement does not necessarily mean that it is wrong. The validity of analytic constructions, to my way of thinking, rests on a constant process of checking and re-evaluation by both analyst and patient, and watchfulness particularly by the analyst in case he has got hold of an 'overvalued idea' as Britton and Steiner (1994) call it rather than what Bion describes as the 'selected fact' (1962, p. 72, 1967, p. 127).
For Renik I think this sort of checking and re-evaluation would not be good enough. It would either be no goal, or a goal based on my 'psychoanalytic' goals, which, he says, are inadequate because circular. For Renik, the only valid goal is therapeutic benefit to the patient. 'Valid insights', he says, 'are ones that produce enduring therapeutic benefit; useful analytic techniques are ones that produce valid insights'. Truth, validity, is what works. This assertion seems to me much too simple. I think that valid insights may be followed by therapeutic inactivity, and, conversely, non-valid insights may be followed by therapeutic improvement that may spring from some other aspect of the analysis-the transference cure, for example, or from circumstances outside the analysis. Something more intrinsic needs to be understood about psychic change, goals and their link with the psychoanalytic process.
In Rachel Blass's (2003) view there is an inherent tension concerning goals in psychoanalysis. This occurs, she thinks, because of contradictory ethical aspects inherent in the value of self-determination and self-realisation to which analysts adhere. These two contradictory ethical aspects are, first, respect for the more integrated self that the patient may become, and, second, respect for the more immediate wishes of the conscious limited self of the patient as he is. Renik, she says, is the most extreme advocate of the second ethical aspect, citing his paper 'The patient's experience of therapeutic benefit' (Renik, 2001). But even he, she adds, respects the first ethical polarity, for he is concerned to bring about therapeutic benefit through insight and self-understanding. Like Marcia Cavell, Blass thinks Renik recognises the opposite polarity more than he acknowledges.
Renik thinks that outcome research would prove what is valid, what works and what does not, a hope about which I am less sanguine than he, for the techniques of outcome research are, I believe, too crude to do justice to the complexity of the issues involved. Further, although outcome research in the more generalised and less 'scientific' sense of what works over time and what does not has been a factor in the development of psychoanalytic ideas and technique, I do not think it has been a major factor. Like Britton (1998), I think the major factor has been the combination of clinical observation and the identification and tackling of apparent obstacles: transference; acting out and repetition instead of remembering; countertransference and changing definitions of it and attitudes towards it; the role of aggressive as well as sexual wishes; changes in the definition of the analyst-patient relationship; and, in the case of Klein, the role of splitting, projection, introjection, fragmentation and integration.
Renik believes that the analytic assumption that self-disclosure complicates the analytic setting is invalidated by the recognition that insights are created intersubjectively. Is this a valid statement? In this case, I disagreed at first and ended in partial agreement. Here I think the problem is one of discriminating between analytically useful disclosures and self-serving disclosures, just as in classical analysis I believe it is essential to distinguish between useful and self-serving 'anonymity'. In a paper called 'The ideal of the anonymous analyst and the problem of self-disclosure' (1995), Renik first attempts to show the self-serving and destructive aspects of the stance of anonymity; I think it is his belief that all analytic anonymity is inevitably unconstructive and anti-analytic. He then defines the nature of appropriate self-disclosure. It should aim to make sure that the patient understands the analyst's analytic activity as fully as possible, and it should be relevant to what patient and analyst are trying to understand about the patient. In Renik's view it is thus a highly selective disclosure, not comparable to the patient's free association, which is supposed to be non-selective, and not used by the analyst to establish what I would call 'symmetry' in the analytic relationship.
In his present brief paper 'Intersubjectivity in analysis', Renik does not discuss whether the intersubjective construction of understanding means that patient and analyst are involved not only in a relationship involving their respective subjectivities but also in what I would call a relationship of 'symmetry'. To my way of thinking analysis is an asymmetrical relationship because one member of the dyad seeks 'help' and the other gives something expected to be 'help'. Judging from what he says in 'The ideal of the anonymous analyst and the problem of self-disclosure' (1995), Renik and I are in agreement on this matter, although we have a considerable problem of terminology concerning use of the terms 'symmetrical' and 'asymmetrical', for in Renik's usage analyst and patient are 'epistemologically symmetrical', meaning that they are equally subjective. But, he says, 'symmetry is not identity' (p. 486). The patient communicates his thoughts to increase his self-awareness; the analyst communicates his thoughts to increase the self-awareness of the patient. Rather like Cavell and Blass, I end up thinking that Renik's definition, in this case of the analytic relationship, is not as different from mine as I had at first thought. I think it is clear that in a general sense I agree with Renik that clinical analysis is intersubjective. How could it be otherwise? But I have also tried to describe some of the ways I disagree with his point of view, primarily with his basic assumptions about the relativism of truth. My basic assumption is that truth exists independently of the thinker and is to be discovered, not constructed. And I also hold to Hanna Segal's recent (2002) statement: 'All science aims at the truth. Psychoanalysis is unique in considering that the search for truth is itself therapeutic'.

References

Bion WR (1962). Learning from experience. London: Heinemann.Bion WR (1967). Second thoughts. London: Heinemann.Blass R (2003). On ethical issues at the foundation of the debate over the goals of psychoanalysis. Int J Psychoanal 84:929-43. Britton R (1998). Unpublished discussion of Owen Renik's paper 'The analyst's subjectivity and the analyst's objectivity' at the British Psycho-Analytical Society. Britton R, Steiner J (1994). Interpretation: Selected fact or overvalued idea? Int J Psychoanal 75:1169-78. Cavell M (1998). In response to Owen Renik's 'The analyst's subjectivity and the analyst's objectivity'. Int J Psychoanal 79:1195-202. Freud S (1913). On beginning the treatment (Further recommendations on the technique of psycho-analysis I). SE 12, p. 121-44. Heimann P (1950). On counter-transference. Int J Psychoanal 31:81-4.Money-Kyrle R (1956). Normal counter-transference and some of its deviations. Int J Psychoanal 37:360-6. Renik O (1993). Analytic interaction: Conceptualizing technique in light of the analyst's irreducible subjectivity. Psychoanal Q 62:553-71. Renik O (1995). The ideal of the anonymous analyst and the problem of self-disclosure. Psychoanal Q 64:466-95. Renik O (1998). The analyst's subjectivity and the analyst's objectivity. Int J Psychoanal 79: 487-97. Renik O (2001). The patient's experience of therapeutic benefit. Psychoanal Q 70:231-41. Segal H (2002). Yesterday, today and tomorrow. Inaugural Lecture for The Centre for the Advancement of Psychoanalytic Studies of the British Psycho-Analytical Society.

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