Attachment and Psychoanalysis – a new vision out of a research discussion group.

Psychoanalysis is a profession that involves lots of talking.  There is the talking – and listening – that an analyst does with his or her patients.  There is also the talking that takes place in supervision and in classes and in other interactions where psychoanalysts are talking about what it is that they do.  Then twice a year (or, in some cases, more often), they get together to talk some more at conventions.  One form of that talking at conventions is discussion groups, which are just that, discussions of aspects of being a psychoanalyst.

This year there was a discussion group that I co-led that created a minor epiphany that I think is worth sharing.  The discussion group was on psychoanalytic research and I presented a model of what happens based on listening to recorded psychoanalyses.  This model, which emerged out of a factor analysis of the data that we generated while listening to recorded analyses, is pretty straightforward.  The model suggests that psychoanalysts and their patients, when all is going well, engage in a kind of parallel play.  While the psychoanalyst listen as a psychoanalyst – meaning that he or she listens to and comments on what is happening between themselves and the patient – the patient focuses on talking about the things in their lives that are problematic.  And when this is going on, the patients are able to engage more and more deeply in describing and understanding the worlds that they live in.

After I walked through this model with a little, but not a great deal, more detail than I just did in the last paragraph (I have included a picture of the model here), a member of the discussion group noted that this is what happens in a psychoanalysis, even after we have made the “relational turn.”  What he meant by this is that there has been a huge transition in how we think about psychoanalysis since the time of Freud.  Freud, who was the only bona fide psychoanalyst who never went through his own analysis, emphasized drives and defenses as a means of understanding the human psyche – and he did not include the drive to attach to others in his theorizing.

As we have watched infants, and as we have gone through our own analyses, we have discovered that we do, in fact, work hard to attach ourselves to people who are important to us.  We have also learned that it is not just the insights that we receive from psychoanalytic interpretation that lead to improved functioning, but it is the quality of the relationship with the analyst that is related to improved functioning (this is part of the relational turn).  This could lead us to suppose that a psychoanalyst should become “touchy feely”.  They should be focused on helping the patient/analysand feel comfortable and warm and, perhaps, connected to the analyst. 

What the person looking at the data was saying, though, is that the quality of the relationship is highest not when the analyst is focused on making the patient feel connected to the analyst, but that the patient feels most connected to the analyst when the analyst is doing psychoanalytic work.  When we engage in parallel play – being empathically attuned to the patient in the context of trying to understand him or her better – then the patient feels able to engage in the difficult work of thinking about how it is that they are related to the world in which they live - and can explore the connections here more deeply.  It is not that the patient becomes dependent on the actual relationship with the analyst (though that is certainly something that occurs), but that the patient becomes dependent upon having a place in which they can function autonomously because the analyst is attending to the stuff that normally interferes with their being able to think clearly about the stuff in their minds and in their lives and how those things interact.

Even after the relational turn, it is the case that it is the support of the autonomous functioning of the patient that appears to help the patient feel and be more autonomously competent.  Not a bolt of lightning, but a piece of illumination that I found helpful.  When I mentioned it to a research colleague who was not at the meetings he noted that it is interesting that though we know that psychoanalysis works, we still have a great deal to learn how it works.

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