The Elusive Concept of the Psychoanalytic Process

Abstract

Although the term psychoanalytic process is frequently used, there is no consensual definition of its meaning. Some authors use it to designate a recognizable set of experiences within psychoanalysis. Others, a majority, use it as a synonym for the entire psychoanalytic experience, describing in detail what analysts do to achieve their goals. A range of views may be found between these extremes. A distinction is drawn here between the structure and content of the psychoanalytic process, which is regarded as a specific, definable entity--a red thread--within the psychoanalytic treatment experience as a whole, consisting of a microprocess and a macroprocess. The former is predominantly an amalgam of the patient's and the analyst's highly subjective experiences and entanglements, while the latter is predominantly an amalgam of the infantile and childhood origin of the patient's difficulties, as well as the analyst's conception of these difficulties based on a preferred theory. These ideas are used to formulate a definition of the psychoanalytic process based on clinical experience and are traced here primarily through lessons learned from a patient, Mr. K, over the course of a long and arduous analysis.

Structural Change and its Assessment

“…Thus, they will argue that structural change is the kind of change that occurs-may only occur and possibly always occurs-if or when there is a psychoanalytic process. Needless to say, "psychoanalytic process" is a vague concept, too, in fact rather a term than a concept, and there are different explications of it, depending, probably, on theoretical standpoints [7,8]. Whatever the definition, in the context of structural change it offers various kinds of circular reasoning.…”

Contemporary American psychoanalysis: A profession? Increasing the role of research in psychoanalysis.

“…He concluded wryly, "What any one analyst means, however, by the analytic process is rarely self-evident" (Smith, 2002, p. 225). More recently, Ornstein (2004) summarized the situation by entitling his paper "The Elusive Concept of the Psychoanalytic Process." Aron (1999) earlier had similarly asserted, "We cannot agree on what success is, on what our goals are, or on what constitutes a true psychoanalytic process because many of us .…”

Paul H. Ornstein, MD (1924–2017)

“…Aware that our clinical observations are not theory-free, Ornstein thought it still profitable to differentiate experience-near from experience-distant observations and employ this distinction to compare psychoanalytic theories. He distinguished the immediacy of the microprocess, driven by the analyst's subjectivity and private theories, intuitive, messy and often hidden, from the extended trajectory of the macroprocess, navigated by the analyst's preferred public theory (Ornstein 2004;Sandler 1983). To evaluate an analyst's interpretive work, he urged that we study the microprocess, that we mark the exchanges between analyst and patient that propel or hinder movement in an analysis.…”