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Blum, H.P. (1981). Some Current and Recurrent Problems of Psychoanalytic Technique. J. Amer. Psychoanal. Assn., 29:47-68.
(1981). Journal of the American Psychoanalytic Association, 29:47-68
Some Current and Recurrent Problems of Psychoanalytic Technique
Harold P. Blum, M.D.
Certain continuing contemporary issues in psychoanalytic technique have been reviewed. The central importance of transference and resistance remains unchanged in the theory of technique, but controversy abounds concerning their optimal interpretation, and the influence of different developmental phases on the transference neurosis. The question of whether transferenceinterpretation is the only mutative interpretation is open to challenge, and extratransference interpretation may not only be auxiliary or facilitating, but valuable in its own right. Interpretation in the here-and-now of the transference alternates and contrasts with traditional analytic efforts to trace transference repetitions to their infantile roots and to ultimately analyze unconscious intrapsychic infantile conflicts. Reconstruction of the patient's past is important in the analysis of resistance, for the uncovering of infantile amnesia, for understanding formative influences on the patient's life, and for understanding the genesis and development of the patient's repetitive neurotic reactions. It is complementary to both transference analysis and developmental research. A wider understanding of the analytic process has evolved, which goes beyond the concepts of transference and resistance and includes studies of the nature and function of the analytic alliance, developmental processes and tendencies in the patient, and noninterpretive ingredients of the analytic process, situation, and relationship. The analytic alliance concept contributes to the understanding of collaborative analytic work and of the prerequisites for effective analytic interpretation. The analytic atmosphere, alliance, attitude, and auxiliary ego functions are all important to the analytic process and are intertwined with the constancy and reliability of the analytic framework and situation. However,
analytic interpretation and insight are of primary importance in the analytic process and its curative effects. Newer understanding of development enriches analytic interpretation, but does not call for any change in analytic technique or departure from the interpretive resolution of the intransference neurosis. Resolution of unconsciousconflict does not necessarily repair developmental failure. Structural conflict should be differentiated from structural deficit, with acknowledgment of the limitations of analytic treatment of structural deficit, deviation, and arrest. Analytic change does not depend on either a transference cure or a cure through the "real" relationship, though noninterpretive elements may be therapeutically beneficial and also promote development. Many different ingredients in the analytic situation operate synergistically in reducing resistance, undoing fixation, promoting insight. Neither a diatrophic attitude nor a positive countertransference are regarded as technically advantageous to Freud's recommendations of neutrality and "sympathetic understanding." The concept of neutrality, so intrinsic to analysis in terms of being objective, nonjudgmental, noncritical, and nonintrusive into the patient's external life, does not encompass an analytic attitude which also represents therapeutic intent, commitment, and sensitivity to the patient's developmental potentialities. Empathy itself is a powerful and vital analytic tool, a prerequisite for analytic work, and empathy is coordinated with but not a substitute for shared understanding and interpretation. Psychoanalytic technique permits integration not only of oedipal conflicts, but of accessible preoedipal determinants and problems of later phases of development, taking into account phase specificity, overlap, and both regressive and progressive transformations.
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