The Technique and Practice of Psychoanalysis, Greenson (1967)
Introduction
Greenson presupposes Freud’s tension-discharge model. According to this model — which Greenson’s mentor, Otto Fenichel outlines in The Psychoanalytic Theory of Neurosis — external or internal stimuli can cause excitation or tension (an unpleasant feeling). When we experience this excitation or tension, we want to discharge (reduce) it and return to our previous state of relaxation. We’re guided here by the principle of constancy, as we don’t necessarily want to remove the tension but simply want it to return to its previous level.
In order to comprehend a mental event thoroughly, we should analyze it from six different points of view.
The dynamic point of view holds that for every tension we experience, we might have some internal forces pushing to discharge the tension and other internal forces pushing to maintain the tension. A slip of the tongue is an example of conflicting inner forces at play. When I inadvertently say something sexual, my id feels tension (sexual agitation) and wants to discharge it (by having sex) while my ego, probably influenced by the superego, is fighting to prevent the id from discharging this tension.
The topographic point of view understands the psyche as producing conscious material and unconscious material. Unconscious material is constantly seeking expression; it is guided by primary process and has no sense of time, order, or logic, and it often involves condensation and displacement. The structural point of view understands the psyche to be divided into the id, ego, and superego. The economic point of view emphasizes that maintaining one’s defenses requires psychic energy. The genetic point of view explores how the past is contained in the present and also the origin of certain behaviors. The adaptive point of view focuses on our inborn preparedness for change.
The goal of psychoanalysis is to resolve neurotic conflicts. A neurotic conflict is a term from the structural point of view holding that there is a conflict between parts of an individual’s psyche. An example of a neurotic conflict is when the ego fights to prevent the id from discharging an impulse; another example is when the ego fights to prevent the id from making an impulse conscious; a third example is the superego making the ego feel guilty for an id discharge.
When we say that a conflict is resolved, we mean that the conscious ego is reunited with an unconscious part of the psyche, either a part of the id, superego, or unconscious ego. We go about accessing these unconscious parts through their derivatives. And we go about accessing a patient’s unconscious derivatives through his free associations, transference, resistance, dreams, symptoms, slips of tongue, and acting out behavior.
Greenson next discusses psychoanalytic techniques. The most important analytic technique is interpretation, which involves making something unconscious conscious. He breaks interpretation down into four parts, confrontation, clarification, interpretation, and working through. Confr
Greenson devotes special attention to the working alliance, which he defines as “the relatively nonneurotic, rational relationship between patient and analyst which makes it possible for the patient to work purposefully in the analytic situation.” The working alliance is vital for a successful treatment.
Resistance
Greenson describes six steps to analyzing resistance.
Step #1: Recognize the resistance. Here you want to assess whether the patient is approaching or avoiding something that has unconscious meaning, you want to ask if he’s providing interesting material or padding the hour with chitchat. “If he seems to be going toward something, I remain quiet until that something becomes clear. If he seems to be going away from something, I wait until that is sufficiently clear, then I recognize this as resistance and proceed to work with it.”
Step #2: Get the patient to understand that he is resisting. One helpful technique for doing this is to point out several examples of the resistance — e.g., “You seem to be avoiding something. You came a bit late, then you become silent, and now you tell me you forgot your dream.”
Step #3: Clarify what the patient is avoiding, why he is avoiding it, and how he is avoiding it. Clarifying what the patient is avoiding is the same thing thing as clarifying what painful affect the patient avoiding. If you can’t identify the affect he’s avoiding, you can ask, “What feelings are you trying to push away?” or “How did you feel when you were trying to describe to me your sexual experience last night?” or “What are you feeling as you lie there silently?”
Step #4: Interpret the resistance. Here we want to understand what fantasies or memories are causing the affects and impulses behind the resistance. Resistances “are not new creations, but repetitions, new editions of past events.” And so although we start with the resistance (the event or affect), we then want to discuss the history of that event or affect. We must be careful not to interpret prematurely, as we want to give the patient the opportunity to feel the strength of the resistance.
Step #5: Interpret the mode of resistance.
Step #6: Work through. This involves repetitions and elaborations of Step #4 and Step #5.
The goal of psychoanalysis is to resolve neurotic conflicts. A neurotic conflict is a term from the structural point of view holding that there is a conflict between parts of an individual’s psyche. An example of a neurotic conflict is when the ego fights to prevent the id from discharging an impulse; another example is when the ego fights to prevent the id from making an impulse conscious; a third example is the superego making the ego feel guilty for an id discharge.
When we say that a conflict is resolved, we mean that the conscious ego is reunited with an unconscious part of the psyche, either a part of the id, superego, or unconscious ego. We go about accessing these unconscious parts through their derivatives. And we go about accessing a patient’s unconscious derivatives through his free associations, transference, resistance, dreams, symptoms, slips of tongue, and acting out behavior.
Greenson next discusses psychoanalytic techniques. The most important analytic technique is interpretation, which involves making something unconscious conscious. He breaks interpretation down into four parts, confrontation, clarification, interpretation, and working through. Confr
Greenson devotes special attention to the working alliance, which he defines as “the relatively nonneurotic, rational relationship between patient and analyst which makes it possible for the patient to work purposefully in the analytic situation.” The working alliance is vital for a successful treatment.
Resistance
Greenson describes six steps to analyzing resistance.
Step #1: Recognize the resistance. Here you want to assess whether the patient is approaching or avoiding something that has unconscious meaning, you want to ask if he’s providing interesting material or padding the hour with chitchat. “If he seems to be going toward something, I remain quiet until that something becomes clear. If he seems to be going away from something, I wait until that is sufficiently clear, then I recognize this as resistance and proceed to work with it.”
Step #2: Get the patient to understand that he is resisting. One helpful technique for doing this is to point out several examples of the resistance — e.g., “You seem to be avoiding something. You came a bit late, then you become silent, and now you tell me you forgot your dream.”
Step #3: Clarify what the patient is avoiding, why he is avoiding it, and how he is avoiding it. Clarifying what the patient is avoiding is the same thing thing as clarifying what painful affect the patient avoiding. If you can’t identify the affect he’s avoiding, you can ask, “What feelings are you trying to push away?” or “How did you feel when you were trying to describe to me your sexual experience last night?” or “What are you feeling as you lie there silently?”
Step #4: Interpret the resistance. Here we want to understand what fantasies or memories are causing the affects and impulses behind the resistance. Resistances “are not new creations, but repetitions, new editions of past events.” And so although we start with the resistance (the event or affect), we then want to discuss the history of that event or affect. We must be careful not to interpret prematurely, as we want to give the patient the opportunity to feel the strength of the resistance.
Step #5: Interpret the mode of resistance.
Step #6: Work through. This involves repetitions and elaborations of Step #4 and Step #5.
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