Abstract:Several clinical vignettes express the unconscious use of the patient's body as containing and enacting a somatic defense until free association enables affect to be found in the clinical setting. In this paper, there is a plea to take the body of the patient as seriously as the mind and language. As Ferenczi eloquently remarked "one needs to have lived through an affective experience, to have, so to speak, felt it in ones body, in order to gain conviction."
“…This, under the everyday surface noise of the analysand, may be an unexpected and new position. The patient may know that the other is listening to them for the first time.(Sklar, , p. 116)She says: “I noticed that on the phone you talked about psychoanalysis. Is it true that psychotherapy addresses current issues while psychoanalysis begins with childhood?” I reply that she is worried that I might also send her away and I point out that we have not yet been able to talk about her childhood, which we would have time to do though in a second interview.…”
From the very first moment of the initial interview to the end of a long course of psychoanalysis, the unconscious exchange between analysand and analyst, and the analysis of the relationship between transference and countertransference, are at the heart of psychoanalytic work. Drawing on initial interviews with a psychosomatically and depressively ill student, a psychoanalytic understanding of initial encounters is worked out. The opening scene of the first interview already condenses the central psychopathology - a clinging to the primary object because it was never securely experienced as present by the patient. The author outlines the development of some psychoanalytic theories concerning the initial interview and demonstrates their specific importance as background knowledge for the clinical situation in the following domains: the 'diagnostic position', the 'therapeutic position', the 'opening scene', the 'countertransference' and the 'analyst's free-floating introspectiveness'. More recent investigations refer to 'process qualities' of the analytic relationship, such as 'synchronization' and 'self-efficacy'. The latter seeks to describe after how much time between the interview sessions constructive or destructive inner processes gain ground in the patient and what significance this may have for the decision about the treatment that follows. All these factors combined can lead to establishing a differential process-orientated indication that also takes account of the fact that being confronted with the fear of unconscious processes of exchange is specific to the psychoanalytic profession.
“…This, under the everyday surface noise of the analysand, may be an unexpected and new position. The patient may know that the other is listening to them for the first time.(Sklar, , p. 116)She says: “I noticed that on the phone you talked about psychoanalysis. Is it true that psychotherapy addresses current issues while psychoanalysis begins with childhood?” I reply that she is worried that I might also send her away and I point out that we have not yet been able to talk about her childhood, which we would have time to do though in a second interview.…”
From the very first moment of the initial interview to the end of a long course of psychoanalysis, the unconscious exchange between analysand and analyst, and the analysis of the relationship between transference and countertransference, are at the heart of psychoanalytic work. Drawing on initial interviews with a psychosomatically and depressively ill student, a psychoanalytic understanding of initial encounters is worked out. The opening scene of the first interview already condenses the central psychopathology - a clinging to the primary object because it was never securely experienced as present by the patient. The author outlines the development of some psychoanalytic theories concerning the initial interview and demonstrates their specific importance as background knowledge for the clinical situation in the following domains: the 'diagnostic position', the 'therapeutic position', the 'opening scene', the 'countertransference' and the 'analyst's free-floating introspectiveness'. More recent investigations refer to 'process qualities' of the analytic relationship, such as 'synchronization' and 'self-efficacy'. The latter seeks to describe after how much time between the interview sessions constructive or destructive inner processes gain ground in the patient and what significance this may have for the decision about the treatment that follows. All these factors combined can lead to establishing a differential process-orientated indication that also takes account of the fact that being confronted with the fear of unconscious processes of exchange is specific to the psychoanalytic profession.
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