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Parsons, M. (1992). The Refinding of Theory in Clinical Practice. Int. J. Psycho-Anal., 73:103-115.

(1992). International Journal of Psycho-Analysis, 73:103-115

The Refinding of Theory in Clinical Practice

Michael Parsons

Our clinical practice as psychoanalysts is informed by theory. We have no doubt of that. Just how the two are related, though, is still a question. An engineer or architect refers to theories of structural mechanics and the behaviour of materials so as to derive the correct procedure for putting up a bridge or a building. It is natural to assume that the practice of psychoanalysis is, or should be, similarly derived from theory: that our theory tells us how to understand the patient's psychopathology and the meaning of his communications, and from this theoretical understanding we discover how to proceed in treating him. Our experience, however, seems to belie this. When we are with our patients we seldom work things out so deliberately. We are immediately involved in the interaction with an individual and we do not generally arrive at our interpretations by using theory to deduce what they ought to be. The nature of the connexion between our theory and what we do in the session remains a puzzle.

The importance of the preconscious stands out in all attempts to answer the question. One view is exemplified by Freud and Fenichel in their responses to a paper by Ferenczi (1928). Freud, responding critically to Ferenczi's notions of the analyst's 'elasticity' and 'tact', says:

What in reality we undertake is a weighing up—generally at the preconscious level—of the various reactions that we may expect from our intervention, and the most important aspect in this is quantitative assessment of the dynamic factors in the situation.

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