This summary and discussion, “Dr. Ted Jacobs: Reflections on the Goals of  Psychoanalysis, the psychoanalytic process, and the Process of Change”, comes from my blog written for the class, Introduction to the Conduct of Psychoanalysis. 

Dr. Ted Jacobs

Jacobs is a venerated and experienced analyst who has written extensively in the field. I should note that this is the first paper to be read in the first class for candidates in their very first year of psychoanalytic training. I believe that it is a worthy choice for that purpose for four reasons. First, it’s well written. The reader will no doubt appreciate it when Jacobs’ patient tells him, “for an amateur, you’re a pretty good writer”. I’d go a step further and say, “for an analyst you’re a very good writer”. If you don’t know what I mean, wait a few weeks and you’ll see. Second, I like him. Jacobs presented at our institute a few years ago. I really enjoyed him. I thought that what he had to say was consistent with what he wrote in this paper. He was refreshingly honest and unpretentious. Third, I think it provides a historical context and a current perspective on psychoanalysis. Fourth, I think it provides a wonderful role model of a fellow who has been doing this work for years and who thinks deeply about it. Beyond this, he obviously recognizes and appreciates the need for ongoing self-analysis and consultation. Anyway, I like it. It feels very alive to me.

In this paper Jacobs conveys something to us of his early training about what constituted psychoanalysis. Then, he describes how his ideas have evolved and shifted over time. From my read of the paper, Jacobs appears to an integrationist – an analyst who takes and effectively integrates diverse theoretical ideas into a meaningful whole.

He reports that in his early days of practice, he saw as his analytic task to uncover and integrate the unconscious fantasy. That is, he would try to help his patient become aware of those aspects of his unconscious that the patient couldn’t fully acknowledge. He understood patients as having various ways to avoid knowing about their inner world. For example, they might “project” or attribute to others those thoughts, feelings and ideas that they found intolerable in themselves. Using interpretation, it was the analyst’s task to help patients become more aware of these (previously intolerable) thoughts so that they could be reintegrated into a more mature, more adult personality.

He notes that Freud’s famous dictum, “where id was there ego shall be”, guided the thinking of the times — until analysts began to notice that a harsh and castigating superego could be just as problematic as an id gone wild. The then familiar tool, interpretation, was applied in an effort to modify the superego’s harsh ways. According to Jacobs’s, in that era analysts were taught first to use defense analysis – that is, to first point out and analyze the defenses and, next, to interpret unconscious fantasy and beliefs. Insight was understood to be the mechanism of therapeutic action. According to Brenner, one of his mentors working through entailed the repeated interpretations aimed at understanding the patient’s pathology. This ostensibly led to a shift to more adaptive compromise formations. The analyst’s psychology was viewed as having a negligible role in the treatment. He notes that this view is still held by many highly regarded analysts.

It should be noted that the local institutes vary considerably regarding the extent to which they focus on the patient’s psychology vs the analyst’s psychology. In my opinion, Training Analysts in our institute operate from a very broad base. Though many profess to be classical analysts – and, indeed, for many defense analysis appears to be the cornerstone of their conceptualization, when one scrutinizes their work closely their intervention appears far more flexible and versatile. I have come to view the training analysts with whom I have worked as, “classically informed”, – just my opinion.

Interpersonal sphere
Jacobs notes that in those early days, not many subscribed to the notion that the unconscious of both analyst’s and patient’s could interact in profound and powerful ways. He adds that many analysts were fearful that if they acknowledged the role of the interaction between the patient’s and analyst’s unconscious they would lose the core of psychoanalysis (that is, the importance of the interpretation of conflict and unconscious fantasy).

An aside
I should note, parenthetically, as someone trained in mainstream non-analytic, clinical psychology, the blatant disregard for the interaction between the analyst’s and the analysand’s unconscious astonished me. Clinical psychology was already embracing some of these notions long before psychoanalysts caught on. For example, client-centered psychologists, such as Carl Rogers, argued that the mechanism of therapeutic action was the therapist’s empathy and acceptance. Although Rogers did not embrace many analytic concepts, he clearly talked about the clinician’s impact on the patient as an efficacious treatment tool. What’s more, he had an arsenal of empirical evidence to back up his contention.

In that same era, developmental psychologists were hard at work – collecting empirical data that revealed that the interaction between mother and baby had a profound impact on the baby’s emotional growth and development. One could easily extrapolate from the mother-child dyad to the analytic one. In the seventies, an abundance of empirical evidence derived from psychotherapy outcome research corroborated the notion that the therapist’s empathy (irrespective of theoretical orientation) was a critical ingredient in change. Similarly, extensive social psychology research suggested that human beings (even analysts) have a very profound impact on each other’s behavior.

These ideas seem entirely consistent with the notion that analyst and patient have a profound influence on each other. Of course, Jacobs is focusing on the unconscious communication, this is what’s insidious – that it takes place outside of the awareness of both patient and analyst. Gone undetected it can have an iatrogenic effect particularly since it so often parallels the patients early experience with key caretakers.

Psychoanalysis and an Effective Treatment

According to Jacobs, in the times past, the analytic goals were clear – to acquaint the patient with the workings of their own mind and, more specifically, to familiarize the patient with the idea that she had an unconscious. This was accomplished by focusing primarily on interpreting unconscious fantasy. For many analysts, increased self-awareness – brought about by interpretation – devoted to the sole aim of resolving unconscious conflict, was the only task. The presumption was that if when the patient’s difficulties emerged in the transference they were interpreted in the moment, change would come about. Yet, this did not always happen. And, many patients were dissatisfied. He notes that this was damaging to the reputation of psychoanalysis and justifiably so.

I appreciate Jacob’s candor here. A few years ago, the American Psychoanalytic Association held focus groups to find out how the public – and, mental health professionals – perceived us. Some were surprised to learn that they found us arrogant and smug. Yet, this perception dovetails precisely with what Jacobs is saying: patients didn’t get what they came for – and, too often, they leave disappointed, hurt, and angry. Conspicuously, some of the dissatisfied were candidates and some of those candidates reacted by contributing to the literature. Unlike some of his predecessors and contemporaries, Jacobs shares his patient’s view that insight alone is not an adequate treatment goal – helping people to change their lives is vitally important. Certainly, as Jacobs described, I have heard senior analysts (though not in our institute) proffer the notion that only bedrock or dynamic change is important – that life change is somehow secondary or not truly significant. I think it’s worth noting that Freud implied in his goals for analysis (to work and to love) that living a more gratifying life was one of the goals of analysis. So, although not shared by all – this notion is certainly not new. In the remainder of the article, Jacobs talks about some of the obstacles that get in the way of emotional or affective insight and change that results in living a more gratifying life.

The Problem of Intransigence

I particularly like what Jacobs has to say here. He asserts that patients don’t change for a variety of reasons. It can be tempting, though hardly productive, to blame the patient. But, often the reasons reside within the analyst’s unconscious communications – communications that are unwittingly shared with the patient.
Clinical Vignettes

Mr. C.

In this vignette, Jacob’s candor is truly impressive. He talks about an impasse with a prominent patient, whom he admired and respected. The patient wished to remain in treatment forever. Perplexed by this state of affairs, over time, Jacobs became aware that he has unconsciously used this patient to prop up his self-esteem. And, for this reason, he unconsciously failed to help the patient recognize, express and make use of his aggression. I thought that it was incredibly courageous of Jacobs to acknowledge his narcissistic, albeit, unconscious use of this patient. I think that this sort of thing probably happens in every treatment, in some way. I thought that it was generous for Jacobs, a senior training analyst, to put this into the literature, so that the rest of us don’t have to imagine that only we fall prey to this sort of vulnerability.
Mr. A.

In this vignette, Jacobs again describes a situation in which he unconsciously tries to preserve his role as the older, wiser, brother, in the treatment relationship. Consequently, although he makes appropriate interpretations, subtly, covertly, and quite unconsciously, he contradicts himself, leaving the patient confused. This sort of gaslighting is not rare in analysis. I think that one of the strengths in our institute is the emphasis on these sorts of unconscious process. In my opinion, this is one of the reasons why it can be helpful to continue supervision and consultation throughout ones analytic career.

Mr. L.

Here, Jacobs presents a case in which there is an impasse. Ultimately, he realizes that this is related to a patient’s early difficulty around locomotion, practicing and separation-individuation. Although intriguing (and, actually clinically helpful to me), this case seemed disparate from the others. In the other cases, he points out how a gap in his self-awareness led him to collude with the patient in ways that he did not recognize at first. In this case, he described how a gap in his knowledge of the patient interfered. To me, the first two cases seem to be related to issues of countertransference (in the original sense) or to patient-analyst, unconscious communication, whereas the third vignette seemed to be related to his not having been fully aware of the significance of a certain aspect of the patient’s early history. Still, I suppose his point is that that there are many reasons for analytic impasses – they may relate to both of these factors as well as others.
Memory and its uses in Psychoanalysis

Jacobs had some, I think, very important things to say about memory. The biggest, in my opinion, was his idea that memory can be used defensively. He seems to be asserting that both patient and analyst can exploit the linking of current (troubling) behavior, ideas or attitudes with early experience in a deadening sort of way. Patients can use story telling or an intellectualized sort of making connections as a way to avoid reliving painful affects associated with early experience. This sort of remembering is a defense against truly remembering (replete with painful affect). He asserts that analytic work – in the here and now – can be most effective when linked with fresh, alive, and affectively-charged memories from the past.

Another aside

An intriguing concept which will be introduced elsewhere in your training is Paul Gray’s idea that anythingcan be used defensively.

Mr. D.

In this vignette, Jacobs presents an example of a patient whose primary transference was a denial of the transference. This yielded only after Jacobs sustained an injury. He noted the patient’s indifference to it and insisted that they explore it. What emerged was a well-spring of pain connected to early significant losses. Both analyst and patient unconsciously colluded in warding off the memory of these painful experiences.

In my training experience, senior analysts did not talk regularly and routinely about their analytic work. No senior analyst presented a continuous case nor did any regale me with stories of treatment impasses or treatment failures or even bad sessions. What I loved about this article – was how incredibly honest Jacobs was about the difficulties inherent in this work. I appreciated his open acknowledgement about the ongoing struggle to know oneself – and, how vital this ingredient is to the work.

Conclusions

He summarizes by noting that when one reaches impasses it’s easy to blame the patient’s biology or resistances and, undoubtedly, these factors are sometimes insurmountable. But, more likely, one should consider the unconscious communication between patient and analyst. The article left me hopeful about the process of analysis and the direction in which the field is headed.

– See more at: http://www.washington-dc-psychologist.com/intro-to-psychoanalysis-ted-jacobs.html#sthash.QNRg6nxz.dpuf

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