On the Nature and Aims of Psycho-Analytical Treatment

In this paper, published in the International Journal of Psycho-Analysis in 1958, Fairbairn draws out what his object-relations theory means for psychoanalytic technique. He wrote it as a set of reflections on Thomas Szasz's "On the Theory of Psycho-Analytic Treatment" (1957). He first restates his position. Libido is primarily object-seeking. Development is to be described by the quality of dependence, not by zonal dominance. The personality is a structure of internal object-relationships: an original, unitary ego splits into a central, a libidinal and an antilibidinal ego, each tied to its internal object. Fairbairn then turns to Szasz. Szasz, following Eissler, held that a patient fit for the classical technique should have a relatively mature and unmodified ego, and he called applied psychoanalysis a form of scientific education. Fairbairn replies that on his theory every ego is split to some degree, so the requirement would exclude children and the very patients analysis was devised for. Patients come to be relieved of suffering, not to explore themselves scientifically. Science offers only explanatory truth, and by accepting a patient the analyst adopts a therapeutic, extra-scientific aim. Resistance then becomes a situation to remedy, not merely a phenomenon to explain. The chief aim of treatment, Fairbairn argues, is the greatest possible synthesis of the split ego, achieved within the therapeutic relationship, by reducing persisting infantile dependence and the hatred of the libidinal object that caused the split. The greatest source of resistance is the patient's need to keep the inner world a closed system. Transference is the patient's effort to draw the analyst into that system; the analyst's task is to breach it and open the patient to outer reality. Fairbairn reinterprets Freud's pleasure principle and death instinct as products of this closed system, and with case material from several patients describes "static internal situations", which one patient called "frozen dramas". Since interpretation is not enough, the real relationship between patient and analyst as persons is the decisive therapeutic factor. On these grounds Fairbairn questions the couch, which he sees as a relic of hypnosis and of Freud's dislike of being looked at, and as a traumatic rather than a neutral arrangement. He describes his own seating, and warns that rigid adherence to classical technique can serve the analyst's defences at the patient's expense.