Article
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.
Main ideas
- Fairbairn's theory rests on four formulations: dynamic psychical structure; libido as primarily object-seeking; development described by the quality of dependence, not by zonal dominance; and a personality made of internal object-relationships. The original unitary ego splits into central, libidinal and antilibidinal egos, each with its internal object. In this paper "antilibidinal ego" replaces his earlier "internal saboteur".
- Fairbairn rejects the requirement, which Szasz takes from Eissler, that a patient fit for the classical technique should have a mature, strong and unmodified ego. On his theory every ego is split to some degree, so the requirement would exclude children and the very patients analysis was devised for. Only considerable anxiety drives anyone to explore their own unconscious.
- Psychoanalysis is a treatment, not a scientific education. Patients come for relief from suffering, and a prominent scientific interest in oneself is often an obsessional or schizoid defence against emotional involvement. Science offers only explanatory truth. By accepting a patient, the analyst adopts an extra-scientific therapeutic aim, under which resistance becomes a situation to remedy and not merely a phenomenon to explain.
- The chief aim of treatment is synthesis, not analysis: the greatest possible reintegration of the structures into which the original ego has split, achieved within the therapeutic relationship. Two further aims follow: reducing persisting infantile dependence, and reducing the hatred of the libidinal object that caused the split. The patient resists because maintaining the split defends against ambivalence.
- The greatest source of resistance is the patient's need to maintain the inner world as a closed system, which perpetuates the relations between the ego-structures and their internal objects. Transference is behaviour within that closed system. Treatment becomes a struggle: the patient tries to draw the relationship with the analyst into the closed system, while the analyst works to breach it and open it to outer reality.
- Freud's pleasure principle is a mistaken generalization from a psychopathological phenomenon: it governs behaviour only within a closed system, while the reality principle belongs to an open one. Fairbairn shows this with a patient who can have intercourse only while lost in fantasies about her father. In the same way, the "death instinct" is the obstinate confinement of aggression, and of libido, within the inner world. Another patient put this as a relationship with the analyst interfering with a "death-circuit".
- Patients hold "static internal situations", which one patient called "frozen dramas": fixed scenes such as the primal scene as an arrested tableau, or a dead father kept as an internal object. Fairbairn reads one patient's phobia of road accidents as a defence against such a defence. Dreams that show the impact of the real relationship with the analyst signal a breach in the closed system.
- Interpretation is not enough, and every interpretation is in fact an intervention. The total relationship between patient and analyst as persons, not the transference alone, is the decisive factor in psychoanalytic as in any psychotherapeutic cure. It corrects the distortions of inner reality and offers the emotional development denied in childhood, with a reliable and beneficent parental figure. How far the closed system is entrenched is the real test of a case's suitability for analysis.
- Fairbairn has abandoned the couch for all his more recent patients. He sees it as an accidental inheritance from hypnosis and from Freud's dislike of being looked at all day. Far from neutral, it imposes a traumatic situation that echoes the infant left to cry alone, or the child isolated during the primal scene, and so colours both the material and the result. Instead he sits at a desk, with the patient in a chair beside it, turned slightly towards him, so that either may look at the other.
- The analyst's traditional detachment, which must be distinguished from objectivity of interpretation, has high defensive value for the analyst. Freud's wish to shield the patient from the analyst's personality may rationalize the analyst's own need for protection from the patient's demands. Fixed session lengths and rigid adherence to a technique standardized half a century earlier can likewise serve the analyst at the patient's expense. The method should conform to the patient, not the patient to the method.