Psychoanalysis from practice to theory. Reviewed by Annalisa Ferretti.

This book edited by Jorge Canestri aims to give an account of the theoretical models actually in use in psychoanalysis today. The starting point for this enquiry is the statement that there are no longer only coherent models, since the expansion of psychoanalysis in time and space has changed the nature of psychoanalytic thought. How does each analyst react to this expansion, this differentiation, this complexity which is always on the brink of fragmentation? And at the same time, what happens to the theories in the actual work of the clinical situation? At which level of thought – conscious, preconscious, unconscious – do they enter and work in the mind of the analyst at work? And how do they combine with one another? How can we compare the various models and form opinions about the psychoanalytic competence of those who use them? How can we learn to communicate better and collaborate on common ground when we find ourselves faced with differences in our ways of thinking and doing psychoanalysis?

The debate on these issues is intricately bound up with certain important questions about the validity of theory according to criteria developed in the scientific field, as well as about the notion of what is a theory in psychoanalytic terms.

The book deals with these issues along three lines of research: the first four chapters and the last one describe the findings of the collective Working Parties, set up by the European Psychoanalytic Federation in 2000, one to investigate Theoretical Issues, and the other to look at Comparative Clinical Methods; in the central chapters of the book, the exploration of these themes is entrusted to individual authors.

The first four chapters gather and exemplify the work of the EPF’s Working Party on Theoretical Issue. The orientation of the research is indicated by the title of the book itself: Psychoanalysis from practice to theory. An examination of “what really happens in clinical practice” serves to discover the underlying theories, in order to observe “the divergences and/or convergences with the theory to which the analyst adheres” but they can also reveal “outlines for new models that could subsequently acquire ‘rights of citizenship’ within the discipline” (Introduction). The instrument devised for this investigation is a map of private, implicit, preconscious theories in clinical practice,

the result of many hours’ analysis of clinical material in seminars, involving participants from various psychoanalytic societies, with different orientations, within the work of the EPF’s Working Group on Theoretical Issues.

In the first section of the book, Jorge Canestri’s introduction illustrates the aims of the research project. The first chapter describes the instrument called ‘The Map’, devised to identify the various levels of theory at work in the analyst’s clinical practice. This is followed by a clinical case which reports in detail a series of consecutive sessions with one particular patient (Fonagy). Lastly, there is a practical example of how to use the map, which Bohleber applies to the clinical situation previously described by Fonagy.

In the first charter - Implicit understanding of clinical material beyond theory - Canestri traces the start of this research back to the moment in the 1980s when the debate began on “one or many psychoanalyses” and their common grounds. At that time, no direct comparison was made with clinical practice, where “the analyst at work, notwithstanding his declared adherence to a particular theoretical model, was actually allowing his comprehension and interpretation to be guided by what Sandler called partial theories, models or schemata, which were for the most part constructed with concepts deriving from different theories integrated unconsciously”.

The aim of the present research is to investigate this integration of concepts taken from different theories, in the hope that this will bring to light “new theoretical segments” with a strong heuristic power. This line of thought can be traced back to Sandler and is based on the thinking of great scientists - mathematicians, such as Poincaré and Hadamard, physicists, like Einstein, and indeed Freud himself - reflecting on the mental phenomena connected to the discovery and invention of new theoretical models, describing the passage from “scientific fantasy to future knowledge”. The research seeks to find a way to reveal the implicit, private, preconscious, models capable of containing new conceptions in statu nascendi.

In the second chapter - The map of private (implicit, preconscious) theories in clinical practice – the authors (Jorge Canestri, Werner Bolehber, Paul Denis and Peter Fonagy) describe the construction and functions of the map along with its six vectors: a series of categories which should be capable of accommodating the various types – implicit, private, preconscious – of theoretical models that analysts use in their work.

The authors illustrate the six vectors, seen as six probes capable of detecting these theoretical segments as they are put into practical use. The vectors, or axes, or dimensions are as follows: 1. the topographical vector, capable of detecting at which of the three levels - conscious, preconscious, unconscious - the theoretical thought of the analyst is situated in a given context; in this category we also find considerations on the unconscious use of theory; 2. the conceptual vector, which includes cosmology and worldviews, clinical concepts, clinical generalizations, the conception of the ongoing analytic process and the theories of change; 3. the action vector which includes listening, formulating, interpreting or concrete actions, i.e. behaviour; 4. the object relations of knowledge vector, i.e. the way of conceiving the history of psychoanalytic knowledge, transgenerational influences, the sociology of knowledge, ways of internalising knowledge, attachment theories; 5. the coherence vs. contradiction vector, which concerns the various theoretical segments, the use of polymorphous metaphors and concepts, creative solutions; and finally 6. the development vector, the conception of development applied to a given patient in a given clinical context.

The following chapter is devoted to the clinical case of Miss R, reported by Peter Fonagy with great care and precision in all its interactive meanderings. Fonagy masterfully conveys the multi-dimensional nature of the analytic experience.

This is followed by a chapter entitled Discussion of public and implicit theories in Peter Fonagy’s case presentation, in which Werner Bolehber applies the map to the clinical material, thus giving a clear example of the use of this instrument. The vectors of the map are seen in action. They effectively take on the role of nets to catch the theories and their segments out of the sea of analytic interaction, while respecting its complexity and its potentially infinite dimensions.

The second part of the book contains contributions by individual authors belonging to different spheres of psychoanalysis, who illustrate the way they conceive of the relationship between theory in theory, on the one hand, and theory in the clinical situation, on the other. The authors are: Gail Reed (Theory as transition: Spatial metaphors of the mind and the analytic space), Samuel Zysman (Infantile sexual theories and cognitive development: psychoanalysis and theoretical production), Jorge L. Ahumada (The analytic mind at work: counterinductive knowledge and the blunders of so-called ‘theory of science’) and William Grossman (Some perspectives on relationships of theory and technique).

Peter Fonagy’s contribution - The failure of practice to inform theory and the role of implicit theory in bridging the transmission gap – moves in a different direction. This author contends that the complexity, diversification and potential fragmentation of psychoanalytic thought makes it necessary to abandon the connection that has always linked the clinical practice of psychoanalysis with the theory, of which it forms the central core and foundation.

William I. Grossman, in Some perspectives on relationships of theory and technique, focuses his considerations on personal and group relations which form “the community of thought”, thus connecting the concept of theory with the notion of culture, thought systems and languages that bind a group together. The author highlights the relationship between theories and the people who use them, and therefore the relationship which binds analysts to their personal training, that is to say, to their analyst, supervisors and colleagues; in other words, a community united by thought and clinical practice.

Gail Reed, in Spatial metaphors of the mind, inquires about the things we call theories and specifically where they operate, in which area of the relationship between analyst and patient, and between the analyst, his unconscious and his objectified thought in verbal form. She suggests they can be located in the transitional area defined according to Winnicott’s description. She supports her argument with some very interesting clinical material, reporting an impasse situation in analytic work with a patient, and the countertransference working through which she needed to kick start the analytic process. Reed identifies the inner shift she was required to make with a change in the spatial metaphor: instead of conceiving herself and her patient as two communicating spheres, she realized that she actually formed part of the patient’s sphere and became aware not only of the way this happened, but also of her inner, personal reasons on which the patient’s sphere had acted in order to capture her from within. Since this work of inner shifting takes place, in Reed’s opinion, within the transitional space, it follows that psychoanalytic theories in the clinical situation belong to the same space, representing transitions between the inner and the outer.

Reed suggests that these metaphors are theories, and that theories serve to provide flexible metaphors which can be used by analysts to re-orientate themselves; they cannot be helped in this task by an authoritarian theory which formulates judgements of a right-or-wrong type.

My impression is that this close identity of metaphor and theory creates too direct a connection between clinical practice and theoretical reasoning. There are no twists and turns which would provide a more satisfactory passage from clinical practice to theory. Perhaps, the issue has been somewhat simplified.

In The analytic mind at work: counterinductive knowledge and the blunders of so-called ‘theory of science, Jorge L. Ahumada presents a clinical case and, on the basis of his report, introduces the concept of counterinductive knowledge: patients possess their own theories about themselves and, on this basis, construct their world and relationships. The analyst brings counterfacts and counterinductive evidence. There follows a passionate and well-informed plea to let sciences based on observation have their particular nature and their methods, without expecting the human mind to function like Newton’s stones. He cites Gregory Bateson’s famous dog: if I kick a stone, I can predict the effect on the stone, but if I kick a dog, the result will be determined by the dog’s reaction, which depends in turn on the relationship which exists between the dog and myself before, during and after the kick.

Ahumada builds a confutation of Popper’s well-known arguments on the criteria of scientificity. He criticises Popper and Grunbaum because both assume the mechanical nature of the workings of the human mind. Popper overlooks the enormous differences between the animate and the inanimate. To combat the theory-realism of Popper and Grunbaum, Ahumada proposes pattern realism: the argument of the kick delivered to the stone or the dog shows that in the case of the dog, we have to bear in mind the causes of and the reasons for the action and the interaction: it requires a logica situs, based on observation and demonstrability.

Ahumada defines the method of free associations and floating attention as the method of having no method. He goes on to distinguish formal from informal logic, limiting the former to the study of strictly cognitive statements. He points out that the knowledge process which takes place in clinical psychoanalysis concerns not only statements addressed to someone, but also the emotional difficulties which distort the statements and preclude them, and especially the way these statements are presented. He distinguishes between formula-theories (such as the theory of gravity) and frame-theories (such as the theory of evolution): psychoanalytic theories are frame-theories, and correspond to explicit parts of the knowledge that underlies clinical practice. To this, there also corresponds a ‘not knowing’ which, in turn, also provides a background, where the unconscious theories of the patient organize his experience in an unconsciously deductive manner.

In Infantile sexual theories and cognitive development; psychoanalysis and theoretical production, Samuel Zysman links psychoanalytic theories to the infantile activity of constructing sexual theories, and reveals a genetic connection between these two mental activities. His complex argument links Freud’s ideas on the theory of infant sexuality, Kleinian unconscious fantasy, and Money Kyrle on the cognitive component present in every instinctive act; he contends that infantile sexual theories form the basis of every research activity. The construction of theories arises from the conflictual terrain of infantile sexual theories, which is that of the elaboration of the Oedipal situation. It is therefore possible to examine theories as products of the human mind, bearing in mind the conditions in which they are produced and the possible relations between the conditions and the theories themselves. Psychoanalysis possesses the instruments and methods which enable us to approach this area of study.

In the third and final part of the book, David Tuckett, in his contribution The search to define and describe how psychoanalysis work: preliminary report on the project of the EPF Working Party on Comparative Clinical Methods, summarizes the conclusions of the European Psychoanalytic Federation’s Working Party on Comparative Clinical Method (WPCCM). With aims and instruments that differ from those of the Working Party on Theoretical Issues, the aim of this research is to discover which psychoanalytic models are actually used, by deducing it from an analysis of clinical practice. This, again, is an attempt to observe directly what analysts do, rather than what they say they do.

The aim of this vast work is to construct a “peer review culture” capable of being more critical, more expert, providing a more reliable basis for our psychoanalytic discipline, since it has become increasingly difficult to establish within the psychoanalytic societies themselves, training institutes and psychoanalytic journals what constitutes good psychoanalytic work and what does not. With the expansion and differentiation in time and space of psychoanalytic models, a potentially damaging situation has been created in which “anything goes”.

The WPCCM was set up in the year 2000 within the EPF with the task of exploring what can be done about the difficulty of defining what is and what is not practiced as psychoanalysis, and how we communicate with one another about what we do.

Tuckett summarizes the research carried out by the WPCCM, which is based on numerous empirical tests of a very simple grid. This instrument classifies six possible types of formulations which should account for all, or almost all, the types of intervention a psychoanalyst may make, as well as five “core components”, i.e. central elements useful to infer the theoretical model to which the analyst actually makes reference. The six types of intervention and the five core components were then used in numerous clinical seminars at which analysts from various European countries participated, to infer the effective central theoretical reference model of the analyst whose clinical material is being analysed. The aim is to shed light on which theoretical models are effectively used in that clinical sequence. In seminar cycles held annually at EPF conferences, the types of intervention and core components have been corrected and modified by use and collective work has been carried out to observe which models are really used.

Having clarified the use and limits of the comparative method, Tuckett summarizes the differences discerned with three examples of clinical work that may be of provisional value at least as a typology. Tuckett shows that the models in use are obsolete with respect to the level of ongoing theoretical debate.

So far, I have briefly summarized the various parts of the book and the contributions, which are well worth a more complete reading. Overall, this volume, edited by Canestri, provides a rich polyphonic outline of the debate on psychoanalytic theory and clinical practice in the present situation, where there are widely differing models at various stages of aggregation and internal coherence. The tripartite structure of the text I have described succeeds in giving an account of the diversity of the work carried out within the study groups, rather than by the individual authors. At the same time, it conveys the need to integrate the two approaches.

The study groups, both the Working Party on Theoretical Issues and that on Comparative Clinical Methods, have devised and made available to us some extremely useful instruments. First, Canestri, Bolehber, Fonagy and Denis’ map and Tuckett’s two-step grid are of great utility whenever we have to deal with clinical material without relying on subjectivity alone. Secondly, the groups undertook very useful seminars for comparison among colleagues, supervisions, clinical seminars with candidates, revision of articles and clinical and theoretical work etc. The utility of these instruments may perhaps be better appreciated if put to practical use. I myself took part in a number of seminars within the WPCCM project and the richness of the experience brought to life the two-step grids, which on paper tend to appear rather schematic. They are, however, capable of creating precious conditions of friendly collaboration and exchange and further analytic interactions, in order to fully understand what we really do and how we can get closer to what someone else is doing. The same applies for the map: a little practice is required, but the fruits are well worth the effort: what may at first appear schematic when read, reveals its heuristic capacity on application.

Yet the text does not only offer us the findings of this research. It also provides a number of individual contributions, which draw from the genetic heritage of the reference model of each and from the personal creativity and profound knowledge of each author. This book with its polyphonic character has its choral parts as well as moments for solo voices. The result is a harmonic work with many dimensions, such as an accurate update of the state of the epistemological discussion on our theories (Canestri, Ahumada, Zysman), the challenge of attempting to understand them using psychoanalytic instruments and concepts (Reed, Zysman, Ahumada), the recognition of the value of the group sharing both thought and practice, and the relationship between these, and again the possibility of using psychoanalytic instruments to understand relations within the group (Grossman), Fonagy’s counter melody, and lastly the proposal – hoped for by Tuckett – of useful instruments (the map and the two-step grid) with a view to establishing a “peer review culture”.