Medicine:Abstinence (psychoanalysis)
Abstinence or the rule of abstinence is the principle of analytic reticence and/or frustration within a clinical situation. It is a central feature of psychoanalytic theory – relating especially to the handling of the transference in analysis.
As Freud wrote in 1914,[1]
The cure must be carried through in abstinence. I mean by that not physical self-denial alone, nor the denial of every desire....But I want to state the principle that one must permit neediness and yearning to remain as forces favoring work and change.
Later formulations
The validity of the abstinence principle has been rediscovered and re-affirmed in a variety of subsequent analytic traditions.
- Jacques Lacan re-formulated the principle via the concept of 'analytic bridge' – the analyst necessarily playing the part of the unresponding dummy to bring the patient's unconscious motivations out into the open.[2]
- Eric Berne saw analytic frustration as a means of avoiding playing a part in the patient's life script.[3]
- R. D. Laing, in the context of the false self saw analytic abstinence operating in opposition to false self collusion: "It is in terms of basic frustration of the self's search for a collusive complement for false identity that Freud's dictum that analysis should be conducted under conditions of maximal frustration takes on its most cogent meaning".[4]
- D. W. Winnicott in the context of his notion of 'holding' the patient emphasised that understanding through verbal interpretation gave a deeper sense of holding than the physical act, use of which by the therapist could blur the symbolic nature of the analytic space.[5]
Debates
The rule of abstinence has come under increasing challenge by Interpersonal and Intersubjective psychoanalysis,[6] concerned about the inflexibility of the rule, and the way its relentless application may provoke unnecessary hostility, even an iatrogenic transference neurosis.[7]
Defenders of the rule, against the practice of the warm supportive analyst, argue against the easy seductiveness of being overly 'helpful' in a self-defeating way already sketched out by Freud himself.[8] The concept of optimal responsiveness – balancing frustration and gratification from moment to moment – offers some mediation in the dispute.[9]
See also
References
- ↑ Quoted in P. Gay, Freud (1989) p. 302-3
- ↑ Jacques Lacan, Ecrits (1997) p. 229-30
- ↑ Eric Berne, What Do You Say After You Say Hello? (1974) p. 352
- ↑ R. D. Laing, Self and Others (1969) p. 123
- ↑ P. Casement, Further Learning from the Patient (1990) p. 96-7
- ↑ A. Fayek, The Crisis in Psychoanalysis (2009) p. 37
- ↑ R. Stolorow et al eds., The Intersubjective Perspective (1994) p. xi and p. 146
- ↑ Janet Malcolm, Psychoanalysis: The Impossible Profession (1988) p. 124 and p. 77
- ↑ S. Akhtar, Comprehensive Dictionary of Psychoanalysis (2009) A and O
Further reading
- S. Freud, 'Observations on Transference Love' Standard Edition XII
- J. Lindon, 'Gratification and provision in psychoanalysis: Should we get rid of 'the rule of abstinence'?' Psychoanal. Dialogues (1994) 4:549-582
External links
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