The formation and maintenance of the psychoanalysis frame is important for the function of setting up an ideal emotional relationship with a patient. It is the ability to know how to help the patient by deducing the emotional projections and barriers that are present within the patient’s psyche (Bishop, 1989).
The concept of psychic reality embraces the image of the external world, which accommodates the internal world in an individual that is composed of masculine and feminine energies. It is important for psychoanalysts to comprehend this existing relationship between the external and internal world so that the patient will not be confused in understanding his or her situation (Bishop, 1989).
In psychoanalysis, both analyst and patient are expected to merge the inner and outer subjectivity of the patient. The analyst’s main role is to figure out what is the scope of that subjectivity and form a suitable analysis of it that will be able to help both of them to find a solution. The analyst should strive to become a part of the patient’s illness in order to arrive at a solution. This is called Transference which is a central element to psychoanalysis (Bishop, 1989).
The door to the past is opened through transference as it seeks to make sense of the present. Objectivity has no place in psychoanalysis because the process is derived from the complexities found within the patient’s psyche. An analyst must be able to honor the patient’s projections of reality for it is there that the solution may be brought to light (Bishop, 1989).
A conceptual frame exists in the process of psychoanalysis in which the mode of transference is indicative of the projections offered by both the patient and the analyst. It is imperative that an analyst maintains the frame by respecting the patient’s time as it is giving the patient an opportunity to handle his or her own problems (Bishop, 1989).
While both the analyst and the patient remain independent, mental interpenetration should be experienced by both parties through the combined efforts of projective identification. It is a process that permits bonding with the patient, alluding to a psychic intercourse. In psychotherapy, the psychotherapist is expected to psychically bond with the patient as a marital partner that nurses the wounded child found within the patient (Bishop, 1989).
Psychological elements within the frame emphasizes on three things: Neutrality, anonymity and avoidance of extra-analytic contact. The first element, neutrality, considers a behavior in which the analyst withholds external manifestations of judgment to keep things professional and the psychoanalytic process unaffected. The second element deals with anonymity, which exhibits separation of an analyst’s personal life from the profession.
It is obscuring personal attributes and judgment from a patient, except if it is considered beneficial to the situation at hand. The last element, avoidance of extra-analytic contact, upholds the professionalism of the psychoanalyst by deciding to evade places where patients would most likely be. This will set limitations between analyst and patient by not encouraging further contact between the two parties aside from those established within the bounds of the psychoanalysis sessions (Bishop, 1989).
Along with these elements, silence contributes a great deal toward intervention in psycho-analytic treatment. It promotes an attitude toward to a gestational state where the individual could combine thoughts and feelings. The space in the room should be filled with the patient’s mind and not the therapists’ knowledge. Silence allows the patient to center on what is inside rather than what is outside. An analyst should take care not to interfere with this process as language may affect its course (Bishop, 1989).
Another thing an analyst should keep in mind is interpreting the silence by giving importance to the transference process, exposing the unconscious mind. The purpose of unraveling such consciousness is to project the instinctual or the here and now. Transference brings rise to object relations connected with the patient’s anxieties toward unconsciousness (Bishop, 1989).
For an analyst to be more attuned toward the needs of the patient, derivatives must be presented in order to clarify what was obtained from the transference. It is keeping the exchange route open and flowing. The frame of psychoanalysis should be preserved in such a way that it allows room for both the patient and the analyst to bond together by figuring out the source of the psychological discomfort. It is establishing a stable connection between the patient and the analyst (Bishop, 1989).
2. Discuss Bion’s Model as it relates to psychological development and psychotherapeutic process. What correlates do you find in the work of Freud and Kohut?
Initially, Bion’s interpretations of the subconscious mind gravitate toward the idea that thoughts precede thinking. He believes that people have existing preconceptions about the environment and their realizations. When these two factors meet, it serves as a basis for thinking (Bishop, 1989).
Bion postulates that each person possesses an inclination to be psychotic (PPP), though it is very much different from being in a state of psychosis. For Bion, it involves a set of process in which sufficient trauma activates the reversion of PPP, enabling one to experience such a state. It is fueled by the death instinct that affects the instinctual drive to kill and the ability to think and feel (Bishop, 1989).
Feelings and thoughts are processed by the patient as a separate entity from him or her; therefore, the psychotic part emerges as a detached state that breaks the linkages between thoughts and feelings. As a result, destructive impulses, intolerant frustrations, hatred and irritability occur within the patient, rendering narcissistic love into sadism (Bishop, 1989).
The patient experiencing this kind of state lives in a state of persecution through the creation of bizarre objects or hallucinations. This part of the personality relies on removing any negative thought-process through projective identification. Most often, projective identification refers to the pathological element of execution but under normal circumstances, it is a mode of interpersonal communications that permits the patient to express his or her feelings for the analyst to make sense of them. Such frightening expressions of the patient create a digestible container in the analyst who accepts the projected reality (Bishop, 1989).
The analyst then interjects such expressions or beta elements surrounding the projection. The analyst needs to acknowledge how frightening the projection is and respond to it appropriately. This process is known as alpha function, which simply associates itself from the feeding ritual of birds. The parent bird feeds the baby by taking the worm and digesting it through the creation of bite-size pieces. When the digestion is achieved, the parent bird regurgitates it in the mouth of the baby bird in order to help the baby bird digest the food.
The human counterpart features the analyst as the parent bird and the patient as the baby bird. The patient projects a reality to the analyst, which in turn is emotionally digested by the analyst and offered back to the patient. The analyst needs to regress in order to process projective identification so that it coincides with what the patient has given (Bishop, 1989).
If the beta element returned by the therapist is unstable, the patient will assume that the therapist is of no help as he or she could not comprehend the situation. This leads the patient to feel misunderstood and alone. From this, the patient starts to project a more violent attitude toward the analyst. The outcome may lead to psychosis if the patient is unable to find another container on which to project the beta elements. The analyst must be able to reframe the beta elements in order to provide the big picture to the patient (Bishop, 1989).
With regard to Kohut and Freud, both place special emphasis on narcissism. Kohut identifies narcissism as a way of rejection by discarding oneself into another’s experience through empathy. It is the primary therapeutic tool that does not connote affect or emotional attitude. The affect is only experienced once the analyst finally comprehends the patient’s circumstance (Curtis, 2008).
While Freud may have discussed how an individual relates to his or her being as an object and creates conflict within if disappointments occur, separating it from the line of development, Kohut believes that the narcissistic line is a long-term process. People take what they can from their environment all throughout their lives, which is what fuels narcissism (Curtis, 2008).
The transference in Kohut’s explanation takes place in the selfobject relationship which provides a mirroring positive response to the patient that is in dire need of it. It is the proliferation of affirmation, appreciativeness, and fulfillment of purpose, which supports narcissism in its most positive sense. The function of this is to supply the emotional deficit that is lacking in the environment of the patient (Curtis, 2008).
One of the major changes that have occurred from traditional psychoanalysis is the introduction of selfobject as a counterpart of the projective identification of Klein/Freud. It sets up primary emotional connections that aid in psychological development. The process is not concerned with the outside notions of the self but of the inner projections that manifests itself through deficits (Curtis, 2008).
Another modification concerns the predisposition of the analyst of the past to take things from an objective perspective to a subjective experience. This view intercepts the existing relationship of the analyst-patient into one unit which also encourages counter-transference on the part of the analyst (Curtis, 2008).
Psychotherapy involves the examination of a patient’s long history and the fragments of mal-attunments that affects his or her sense of self. The role of the analyst is to assist the patient in re-establishing the nuclear self and assesses realistically the positive side of the patient’s psyche. This is the only way for the patient to willingly internalize the deficits through optimal failures. Failure is essential to the growth of an individual since it helps develop perseverance and maintain a healthy ego. Psychotherapy helps in the process of arriving at the selfobject needs of patient through the awareness of the existing deficits and responding empathically to it (Curtis 2008).
Bishop, A. (1989). Classical psychoanalytic technique. In R. Langs (Ed.). New York: Guilford Press.
Curtis, R.C. (2008). Desire, Self, Mind, and the Psychotherapies: Unifying Psychological Science and Psychoanalysis (The New Imago). (1st ed.). New York: Jason Aronson.