Saturday, July 26, 2014

A few first principles for analytic technique

This is my first stab at analytic technique for patients who are pre-genital but aren't so regressed that they can't handle some activity from the analyst.

As with many of my posts I'll probably end up recycling it and give more examples of the processes involved and break up the stages into sub-sections.

I'm not sure how valuable it could be to anyone at this point but here it is.

ego- superego- id

1. ego- see whether the patient is leading the initial talk about their life in regards to their ego (social) drives or object (sexual relationship) drives.

-don't interpret and challenge but ask client questions about others and their reactions to them to get the patient to tell the fullest story, or, if the patient is too regressed then you'll have to approach from a modern analytic or Kleinian technique

-you are looking for recent social humiliations or disappointments in love with parental-substitutes

-you are also looking for life-long patterns or repetitions

-you are waiting for a transference to form and you are storing information that later techniques may refer back to.

-you are looking for chronic inhibitions of aggression/self-assertion and affection/empathy

2. superego- at some point you will begin to see what ontological relation the patient is in regards to the ego or object drives. For example, is he concerned about his image or success, or is he concerned with being a member of society or not, is he concerned with having a perfect life or not. In the object drives, the patient might have no place in her life for a man, might have a current relationship in which she is identified with the parental imago and treating her partner like she used to be treated, etc. The ego defences will be worked through at the same time as the patient's relation to the father-substitutes is being spelled out.

In the ego drives one can offer 'holding statements' about how the patient functions in relation to the social body. For example, you have a common patient who is living below their potential. He is in a mediocre job and there is criticism of his boss, the idea that he doesn't want to "pretend to be busy" and isn't getting enough direction from his boss, and observations about what the company might do that he doesn't share or shares half-heartedly. This situation naturally brings to mind the opposite picture in which there is an ideal in which the patient's time is used efficiently and he is led by a boss who is perfect to realize the fullest potential of his job. The patient on their own will begin to compare their current employer to other employers and the picture will emerge of the ideal father-substitute that is needed and you have to get the patient to begin to express him in his imagination.

The perfect use of time (volar trito) is in confluence with the anal father-substitute who represents the superlative father who the patient needs to join "society" and work-life.

In the object drives the reference to the social body is less explicit. However, there is often reference to how much time and control the sexual object wants. Many narcissistic patients will have a partner who wants to be the only person in their lives and doesn't want them to have any friends or leave the house. This can be represented mythically. The jealous controlling boyfriend seems like some dragon or ogre who lives outside of society and keeps the patient as his treasure. This representation obviously gives the sexual object a lot of power and this is what the patient has to express in the fantasy. Whether she is making a narcissistic object choice, secretly feeling more powerful than him by taking care of him, feels inadequate to live life on her own, striving to restore him to his former glory or potency, etc. his place of power in relation to the social body should be spelled out and then ego defences on both the egoistic and altruistic poles can be analyzed.

3 id- you don't have to just analyze the transference, but can also study extra-transference relations because you are searching for aggression and affection in recent narcissistic injuries and disappointments in love. By following slips, dreams, and asking for associations for idiosyncratic word choices you either find phantasies that can be used in transference interpretations, you can find self-states that allow the patient to more fully elaborate her defusions and defences, and you he or she can express the ego drives functioning in relationships that aren't conscious.

These techniques take you back to both the superego (2) and ego (1) stages of work. However, the distinctively important id work has to do with the specific forms of aggression and affection that need to be expressed.

When a slip leads the patient to tell a story from her past that is triangulated you should always perk up and wait for the id impulse of aggression and affection to become noticeable. When the patient, for example, gets angry as she is telling the story you can acknowledge this anger in her and ask her to note where it is in her body. Ask her where she feels power and where she can attack someone and damage or hurt them. Often they will reference the body part. Power, for example, will be felt in the hands and impulses to strangle might be felt. After she stays with these body feelings you can instruct her to imagine attacking someone (or, if you're a somatic psychologist you can actually have her strangle a sheet or pillow). It is always important, however, to elicit the words and what she would like to say to the object of the aggression.


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