If the therapeutic experience may be characterized as one of lifting the veil from what we typically conceal — even from ourselves — then the practice of psychoanalysis is an inherently dangerous proposition. If we are to place ourselves at risk with what we are about to discover about ourselves — the analyst as well as the patient — then it behooves us to proceed with a measure of caution. It is one thing to say this and another to put it in effect, to be wedded to it. Since the inception of psychoanalysis Freud took pains to harness the potential for inflicting harm on one’s patients by formalizing a set of constraints that were conceived as rules, or recommendations, to follow. Between 1905 and 1915 he crafted a series of technical recommendations that were paradoxically intended to restrain psychoanalysts from the temptation of doing too much (therapeutic ambition) for their patients, while protecting themselves and their patients from the risks unavoidably encountered in this enigmatic treatment methodology.
Instead of providing instructions about the do’s and don’ts of the analytic experience, Freud offered nothing more palpable than a set of first principles that merely assigned the respective roles that analyst and patient should play. Although some have complained about the paucity of instructions Freud offered, we have come to appreciate from our clinical experience the limits of what practitioners can be told what to do, no matter how many years of instruction or supervision they accrue. If anything, therapy students today are over-trained. Their work is scrutinized, supervised, and evaluated by others who, try as they may, cannot possibly know what it is like to be in the room with the person the student is treating. Freud did not write a manual on how to conduct psychoanalysis because he concluded that everything of a positive (i.e., interventionist) nature should be left to tact and the analyst’s own judgment, whereas the principles themselves should remain, like a moral fable, of a cautionary nature. In this sense, Freud’s technical recommendations are nothing less than ethical precepts, because their purpose was to formulate a working terminology with which the analyst’s experience could be articulated and communicated to colleagues. This is why the Hippocratic counsel, “do no harm,” remains the paramount consideration, not the utilitarian goal of success by any measure.
Ultimately, analysts must come to terms with these principles in their own way and interpret them to the best of their ability. Yet, a typical, contemporary study of psychoanalytic technique leaves little to chance and less to the imagination, written as though it should be obvious what should — indeed, must — be done, when, and to what degree. The principles themselves are now so diluted that analysts no longer know what to make of them, let alone how to adapt them to their necessarily idiosyncratic personalities. This, however, is not an historical account but a practical one for my purpose is to show that psychoanalysis has not, as some insist, “progressed” over the course of the last century but, on the contrary, has lost something in the transition: I am referring to its edge.
It is my impression that psychoanalysis, like an old codger, is dying, and analysts have no one to blame but themselves. I know I am not alone in this, though I suspect this assessment will shock some in parts of America who do not appreciate the gravity of the situation. American culture has turned against it, and who can blame them? In parts of Europe and South America psychoanalysis is on the cutting edge, because it still has an edge that cuts. This was always its intention, Freud’s intention, to cut, wound, elicit bleeding, if not blood then passion, suffering, angst. The best patient was the one whose back is against the wall, ready to take a leap over the precipice, given a chance or hope to exist. Only a fool could be expected to endure what would follow. It was no, as Frieda Fromm-Reichmann suggested, bed of roses. The dreadful, as Heidegger observed, has already happened.