The Future of Psychoanalysis

5. The Secret Life of the Psychoanalyst

Perusing the psychoanalytic literature reveals a scattering of papers hinting that even the best theorists in the various schools of psychoanalysis do not, in the privacy of their offices, meticulously practice as prescribed by their specific theoretical orientation. This leads to a number of problems that perhaps it is time to bring out into the light. For example, Rangell (1974) points out that as analysts we must justify a treatment that goes on for an indeterminate number of years, and it is not sufficient to excuse it by arguing that the patient would be in a mental hospital without it. He points out, as others have also done, that being in analysis four or five times a week can become a way of life and even a substitute for ordinary life and its responsibilities. It is the obligation of the analyst to prevent this from taking place. Rangell is especially hostile to the Jungians and the Kleinians. He writes: “Jung’s mysticism does not belong to rational psychoanalysis . And more within the analytic body today, the interpretations of some about the earliest months of human life survive their absurdity for a while only by their shock effect” (6). SYNDROME OF THE COMPROMISE OF INTEGRITY Rangell introduces what he calls “the syndrome of the compromise of integrity.” This concept has not received the attention it deserves. For him, it represents a struggle between the ego and the superego that results from a constant baseline tension between them. In the compromise of integrity, the superego is partially sacrificed and the ego may deny or postpone its own 81 5 The Secret Life of the Psychoanalyst interests. According to Rangell, the great enemy of integrity is narcissism. Uncontrollable and unsatisfied narcissism forms the strongest motivation to the compromise of integrity. As Rangell puts it, “Instinctual pressures are then to neuroses as ego interests are to the compromises of integrity” (8) and he feels that “the whole question of the relation between the unconscious and responsibility needs, in my opinion, a searching re-examination” (10). Rangell further and correctly proclaims that “The analytic attitude is in its very essence the model . . . of relentless incorruptibility” (11), and,“Analysis aims at turning out an honest man” (10). But we all know there is a tremendous pressure all day long from patients that arises from sexual and narcissistic aspects of the patient-analyst interaction, which leads to the temptation to abuse transference and to many other unfortunate phenomena. But, as Curtis (1980) points out, sexual feelings of a male analyst for a beautiful woman patient become a source of difficulty “only in proportion to the amount of infantile motivation contributing to the reaction. Experiences of this sort have led to the saying, ‘analysis is an old man’s game’” (163). Not only sexuality but aggression can attach a patient to an analyst, since the analyst is the only one who does not retaliate against the patient’s sadism; the task of the analyst is to interpret. In addition, aggression can be expressed in sadomasochism along with a strong mix of sexuality! Narcissistic rage, which is never far from the surface in the analytic situation, needs to be transformed in order to avoid serious interpersonal disasters . Here is a call for Kohut’s (1971) transformations of narcissism into empathy , wisdom, creativity, a sense of humor, and an acceptance of the transience of life with which every analyst by now should be familiar. Unavoidable narcissistic injuries and the concomitant narcissistic rage must also be transformed into modulated, tamed responses as part of every psychoanalysis. Where does all this stress and pressure of the “impossible profession” lead? According to Sandler (1983), it leads to the conscious or unconscious conviction of many analysts that they are not doing a proper job of psychoanalysis and that colleagues would criticize them if they knew about it. Sandler believes this comes from the fact that: Any analyst worth his salt will adapt to specific patients on the basis of his interaction with those patients. He will modify his approach so that he could get as good as possible a working analytic situation developing. To achieve this, he needs to feel relaxed and informal with his patient to an appropriate degree, and at times he might have to depart quite far from ‘standard’ technique. He may be very comfortable with this as long as it is private rather than public, especially in view of the tendency for colleagues to criticize and ‘supervise’ one another in...