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Psychoanalysis vs Psychotherapy

48:36 recording · AUTO · 1 speaker

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Brief overview

What separates psychoanalysis proper from analytic psychotherapy is deliberately evoking and analysing a transference neurosis.

  1. Truth therapy dismantles defences, lie therapy rebuilds themLangs' basic distinction: analyse resistance to reach the truth, or strengthen a collapsing resistance because the patient cannot bear it.
  2. Transference is everywhere; transference neurosis is notThe speaker has transference to his dentist and his grocery deliverer, but a transference neurosis takes months and makes the analysis itself the patient's obsession.
  3. The analyst mirrors the patient's regressionBird says every transference neurosis produces a countertransference neurosis, which is why a destabilised analyst should return to analysis, supervision, or stop practising.
Executive Summary AI
  • Answering two questions from Gavin Behrens, the speaker sets out to distinguish psychoanalytic psychotherapy from psychoanalysis proper and to describe how his clinical technique shifted over his career.0:00
  • He builds the first distinction on two Robert Langs papers from around 1974 or 76, "Truth therapy / lie therapy", where lie therapy rebuilds crumbling defences and resistances rather than analysing them, and he counts psychopharmacological treatment as a variety of lie therapy, against Kierkegaard's view that symptoms are messengers.2:12
  • For the second distinction he turns to Brian Bird's paper from the early 1980s, which separates ubiquitous everyday transference and the early "floating transferences" from the transference neurosis, where the patient stops talking about symptoms and becomes obsessed with the analyst and the analytic relationship, in love or in hate.11:58
  • According to Bird, Freud first defined psychoanalysis by the emergence of the transference neurosis, promoted by three to five sessions a week on the couch with a silent analyst rather than once-a-week work in a chair, and then backed away as he saw it regress into transference psychosis, with acting out, stalking, analysts having sex with patients or getting into fist fights, and a matching count25:34
  • His own position is that the transference neurosis is what distinguishes psychoanalysis from once-a-week analytic psychotherapy, illustrated by a Montreal colleague, later the only analyst in Calgary, whose teachers nearly threw him out of training for telling a new patient she did not have to fall in love with him — a view much of the field has since come around to.40:53
Key Quote
“I'm not God. I don't have a crystal ball and I'm not omniscient.”
— Speaker4:37
Key Quote
“You know, Surin Kierkegaard said, don't make the symptoms go away.”
— Speaker6:12
Key Quote
“Transference is ubiquitous.”
— Speaker12:51