Posted by badhaircut on December 22, 2003, at 11:17:47
In reply to Re: psychoanalysis (unfavorable review), posted by lookdownfish on December 22, 2003, at 3:39:25
> What are the criteria for success? How can an analysis be called successful if none of these things have happened?
THE GOAL
I think the "official" criterion for success in psychoanalysis is that both the analyst and the patient agree that it's complete -- not just ended or at a standstill, but complete. "You'll know," my analyst told me. It deals with a felt sense of self-understanding.That's why someone who flies into temper-tantrums, abuses those close to her, makes destructive choices in love, or is wracked with emotional pain, can still be said to have had a successful psychoanalysis. I think the best actual outcome that fits inside the official goal is that the patient has a less fearful attitude toward the emotions and ideas that come up from inside her. Even if they're nasty thoughts and feelings, the patient doesn't keep them in the Unconscious -- where they would still be active. The successful, completed analysand allows all these demons into consciousness, where she can make choices about them. Now, with those post-analysis choices, she might improve her life in the conventional ways (love, job, mood, etc) or, so choosing, she might not.
INEFFECTIVENESS
That's great. I think fear of spontaneous thoughts and feelings is at the heart of most personal dysfunction and their acceptance is a cornerstone of long-term happiness and enjoyment of life. I think most improvement is about conscious choices. But I also think that psychoanalysis is a roundabout, haphazard, goose-chasing way to have self-acceptance or choice-making skills -- and it's burdened with tons of dogma and rituals that are irrelevant to self-acceptance and can even obstruct it.ASSESSING SUCCESS
Because analysis is so poor at getting to even this one concrete goal, sincere, well-meaning analysts are (unconsciously) afraid to specify any dry, external, controlled measures for assessing it. Some might go so far as to deny any specific goal at all! In order to keep the Faith in the enticing, richly imaginative, *fun*, literate, burgeoning world of psychoanalysis, the analysts have to believe that its success can be measured only by them and their thoroughly analyzed (and indoctrinated) patients. That's why "success" must simply be at best the heartfelt agreement between the two in the dyad that the analysis is finally complete.And since cognitive, behavioral and drug therapies started publishing externally-measured, statistically-sound reports of life-improving success, psychoanalysts know that they can't even *imply* anymore that analysis will bring such verifiable results. (Real-life improvement was Freud's original claim, later retracted.) So they may allow patients to get the impression that some tangible, unique benefit will eventually come, but if a patient asks for specifics, the analyst will compassionately shrug that it's just too personal to describe.
RESPECT FOR ANALYSTS
I'm not being cynical. I was *INTO* psychoanalysis for years. I believed. I've read (and have) shelves of Freud, Klein, Winnicott, etc, and I almost entered a psychoanalytic clinical PsyD graduate program as a career move. I know that many psychoanalysts are sincere, thoughtful, smart, open-minded, compassionate, good people. Mine was. I'm only saying that to the extent they're practicing psychoanalysis, they're effective at trivia. To the extent that they're striving for demonstrable life-improving changes, they're engaging in some other therapy.--------
lookdownfish-- on Freud's unconfirmed theories: I didn't mean just the metaphor of superego etc, but his actual clinical techniques still practiced today. I'll try to post more later. (I too love your name.)
poster:badhaircut
thread:291847
URL: http://www.dr-bob.org/babble/psycho/20031221/msgs/292364.html