Psychotherapy Integration Papers

Correspondence between Lawrence Friedman and Tullio Carere-Comes

 

 

Dear Dr. Carere, 

 

I am very grateful for your attention to—and clear discussion of—my ideas, and for sending me your fascinating article.

I would agree that the principles of psychoanalysis and psychoanalytic psychotherapy are the same.

I find your ideas about the need for flexibility in foregrounding strategy or tactics very plausible.  I do have some old-fashioned reservations about the flexibility.  I think there are problems with a goal-defined treatment in contrast to a technique-defined treatment.  For one thing, most goals (e.g., "understanding") are hard to define, and when they get defined by the exigencies of practice they can become labels for an old and comfortable way of doing things.  I don't have a formula for resolving this practical problem.  I suppose I go along with the old, common view that psychotherapy allows more tactical maneuvering, whereas analysis is more technique-committed.  We both agree that there is no goal so well known that we can just try to get at it in any old way.  But then I could respect innovative therapies that do just that.

 

Tullio Carere-Comes:

 

Dear Dr. Friedman,

 

Thank you for your kind words.

We surely agree that "there is no goal so well known that we can just try to get at it in any old way".  This is not the same as saying, though, that psychoanalysis has nothing to do with goals.  I like Thomä & Kächele's definition of psychoanalysis as "an ongoing, temporally unlimited focal therapy with a changing focus".  This definition seems to me to go the middle way between excessive focusing on goals or issues, and total (and illusory, in my view) absence of any focusing.  I would go even further than Thomä & Kächele.  In their view the foci are interactively determined, but the patient's contribute is only unconscious.  In my view the appraisal of the patient's conscious contribution as a major factor in the interactive determination of the changing focus would help bridge the gap between psychoanalytic and cognitive-behavioral approaches.

 

 Lawrence Friedman:

 

With regard to the second Benvenuto quotation, it may be impossible to be definitively "objective," but can't one aspire to being objective?  I think you feel we can.

I very much enjoyed your respectful critique of some relativistic postmodern currents, their merits and their hazards for treatment rationale.  You make an extremely important point in emphasizing the danger of manipulation in approaches that superficially seem to be non-authoritarian.

            Bravo!  for bringing Piaget to bear on the hermeneutic problem.  I think you are absolutely right in this formulation.  On the other hand, I'm not as ready as you are to find Heidegger "lucid." 

 

Tullio Carere-Comes:

 

I find Heidegger often enlightening, rarely lucid. Sometimes, though, he has a lucid point.

 

 Lawrence Friedman:

 

I am absolutely fascinated by the notion of an "affect of truth."  It is a great end-run around the problem of a new meaning that's also an old truth, and the problem of the signal of correctness.  I find your discussion infinitely valuable.  Do you think there may be more to be said about this -- more detail, more explication?

 

Tullio Carere-Comes:

 

We owe the notion of an "affect of truth" to Benvenuto. You will find more detail and more explication in his papers, on-line at the Journal of European Psychoanalysis web site (http://www.psychomedia.it/jep).

 

 Lawrence Friedman:

 

 Your discussion of the leap into newness reminds me of one current trend here among some Sullivanian theorists to replace specific Freudian fears with fear of novelty as the pathogenic factor that treatment overcomes.

In regard to your discussion of Napolitani, I find it plausible to stress the infinity of meanings and abstractions that humans can achieve, but implausible to go the whole existential route.  In fact that strikes me as a bit of hubris.  Freud may have been overly reductionistic, but I don't think he was wrong to see man as still an animal, for all his pleomorphism.  And when I look around me now and back in history, it seems to me that I see a lot of repetition and sameness in that animal.

I am sometimes amused by theories that make it seem that flexibility is one of the most prominent findings in the practice of psychotherapy.

 

Tullio Carere-Comes:

 

We can see repetition as the effect of an innate compulsion or of learning, but the aim of therapy (analytic or whatever) is in both case the same: to free  the person as much as possible of the repetitive patterns that trap them. We may not go very far along this way. But is there another way that makes us human?

 

 Lawrence Friedman:

 

I love your formulation in Part 3 of the self-interpretation that traps the patient, and that he must come to see in that light.  And I loved your critique of the Lacanian rationale.  I think you are quite right.

You are right that the adversarial attitude has a persecutory shade.  I would argue that "persecutory" is a precise description of part of the analytic atmosphere in its historical reality, and in its popular image.  That is now being softened and even sometimes abolished.  It is often resented by older analysts as they recall their training analysis.  Beside being an historic fact, I do think that a vaguely persecutory shade contributes to the action of analysis (and I think we should call  a spade a spade).  Of course, if that was the patient's main sense of the analyst's attitude, it would be counter-therapeutic.  And there must have been many such examples.

            I think your concluding schematism, critiquing my one-sided-ness, and placing my polarities in a larger, dialectical context, is wonderful.  I think you are right that it is a dialectic.  After all, if I don't quite "believe" my patient's presentation of himself, he will subtly feel me to be accepting (or at least appreciating) something else he can't otherwise display, and he will sense that he is being given more leeway than when he is accepted on the terms he demands, as in the rest of his life. 

 

Tullio Carere-Comes:

 

That is what I guessed: it is not that your approach is not dialectic, it is that your dialectic is more implicit than explicit. As I made it clear in the final paragraph of my article, I have tried to make explicit what was only implicit in your work.

 

 Lawrence Friedman:

 

    Still, isn't there a separate question about the analyst's working psychology?  How must he figure himself in order to create the four-fold field of forces?  How should he be thinking to combine flexibility and discipline, routine and novelty, endorsement and skepticism, etc.?  You might say that if the four-dimensional dialectic is the truest description, then that's what the analyst should have in mind.  But that is an empirical question, not a theoretical one.  And I don't think the final answer is in yet.

 

Tullio Carere-Comes:

 

The passage from an implicit to an explicit dialectic surely helps the analyst (or, for that matter, any therapist) to find a balance on a moment by moment base inside the different polarities. This passage is clearly not just a theoretical question. I am not sure to understand what you mean by an "empirical question". If it is empirical research that you have in mind, we are very far from any decent answer, leaving aside the final one. If instead you think of an empirically (i.e., experientially, not just theoretically) grounded dialectical ability of the analyst, my answer could be that a dialectical ability that is not grounded in experience is no dialectical ability at all. But I would say the same of any practical ability; therefore I do not think that I hit the point.

 

A better answer could be the following: In order to "combine flexibility and discipline, routine and novelty, endorsement and skepticism, etc.", the analyst should install what I have called an "O vertex" in the relational field. In this vertex the analyst knows that he or she knows nothing. With the attitude that Bion called "Faith in O", the analyst entrusts him or herself to the unknown, meant as a generative matrix, and the non-theoretical source of all theories. This enables him or her to let go of any identification with specific theories and techniques. Without Faith in O, clinging to one's theories and allegiances is almost unavoidable, for fear of falling into a meaningless and destructive void. The presence of this faith, on the contrary, allows one to distance oneself from whatever makes up one's identity, making thus possible flexibility, novelty, and radical skepticism.

 

 Lawrence Friedman:

 

It's a great essay, and I'm honored to have been the occasion of it.  Thank you again for writing it and sending it to me.

 

Lawrence Friedman rejoinder:

 

Dear Dr. Carere-Comes,

 

Thank you for your comments. You start me thinking in many interesting directions.  For the moment, let me just try to be a little clearer about what I called "an empirical question."  I was referring to the effect on therapy of the particular conceptualizations (or lack of them) in the analyst's head.  It may turn out that a certain kind of ignorance or illusion is necessary for the optimum balance and/or flexibility.  I am temperamentally inclined to think that humility is the most realistic and therefore most useful avenue to the position we desire, but there is always the possibility that it isn't.  I find what you say congenial, but I'm not sure that we will turn out to be right.  Isn't it a matter of the analyst's own psychology (not just his line of thinking)?  He may need to have faith in something else than "O," in order to have the tranquility to be receptive.  Do we know—really know—what Bion had faith in?  But I am way out of my depth here, and leave it to you to elaborate that dimension.

 

  Once again, thank you for the rich discussion in your work and correspondence.

 

             Cordially,

 

                Larry Friedman