The Centre for Freudian Analysis and Research recently held the second of their annual conferences dedicated to the theme of the relation between characteristic styles of British and Lacanian clinical practice. The Conference was entitled "Lacan and the British Tradition II", and was held in the University of London Union on 29th November, 1997. The theme that is being developed in this series of conferences is intriguing as well as enlightening: a cross comparison of clinical orientation sheds much light on the nature of psychoanalytical work. This year, the focus of the meeting was on the concept of cure in psychoanalysis, and in particular the notions of the direction and the end of the treatment.
Darian Leader of the Centre for Freudian Analysis and Research opened the day's events with a talk entitled "How many times does an analysis end?" He started with the observation that people often feel that their therapy is over after two or three years. This is a surprising feeling, since it certainly does not coincide with any disappearance of symptoms. Rather it generally follows what can be called a "phase of passion", and this "sense of an ending", if it is put into question can tell us something about the end of analysis. Darian looked at the positions put forward by Szasz - an ending is a "never-ending ... scientific attitude" - and by Rado, Sachs and Glover in their differing formulations of an end being an ideal point that is approached, or rather a process that may need some repeating. In giving attention to these issues of repeated looping at the end of analysis, Darian parallelled the musical process of "working through" with the corresponding process experiences in analysis. He put forward the formulations proposed by Lacan, who constructs a variety of spaces in each of which this looping has various forms - ordinary place, toric spaces and projective planes. This may seem a little abstruse to Anglo-Saxon ears, until one remembers that this is precisely the point at which Bion left things - these speculations about projective spaces in analysis - and that Lacan, in mans, ways, is simply taking up again at the point where Bion had left off.
There was then a panel on "endings" which contained three presentations. Kirsty Hall of the Federation for Independent Psychotherapists and the Arbours Association focussed on the notion of "tradition" in the theme of the conference. She took some warnings - mainly from Raymond Williams - about the constraining and repressive effects of tradition. And these warnings clearly apply as much to French as to British traditions, save that she takes the ethical imperative introduced by Lacan - "Return to Freud" - as an attempt to save Freud from tradition. She found tradition contested at the time of the controversies over technique that took place in Britain at the time of the Second World War. In particular, Ella Sharpe's contribution to the Memoranda on Technique contains an appreciation both of the limitations and incompleteness of knowledge, and of the problematic nature of reality exposed by analytical work. It is one of the functions of tradition to protect against exposure to reality, and it is in this context that Kirsty raised the question of the existent traditions about termination in the analytical movement. As the effects of these traditions are weakened, there are places that can be rescued for the operations of the functioning of desire.
Margaret Campbell of the Centre for Freudian Analysis and Research then raised the question of the dialectical nature of the analytical relationship according to Lacan. This lacanian dialectic leads to the formulation that the end is a conclusion - a moment when the analysand can make conclusions about their desire. She stressed that in this respect the end is neither an identification, nor a strengthening of the ego, nor an adaptian to reality, nor the attaining of happiness, nor the disappearance of the symptom, not even the cure of some underlying disease. She focussed on the themes of symbolic castration - centralised in Lacan's reading of Freud - and loss of "satisfaction stemming from ... the ego-ideal". She then wove these themes into the network of terms that she takes from Foulkes and Bion on the functioning of an analytic group, concentrating especially on Foulkes' term group matrix - "a web of free association". Her main case material came from a group, three central characters of which she named Sherry. Doris and Simon. Sherry "lacks a voice- and positions herself against the conflict in the group between Simon and Doris. In the process she finds that her silence is implicated in their antagonism, and by this means she finds aggressive feelings towards her mother. Discovering that she can be other than "good.' allows her to loosen her attachment to taking up an ideal position of silence both in the group and in relation to the warfare between her sister and her mother - with her incapacitated father as a mute observer. What is often presented as a focus on "language" in this case shows itself as work on associative threads that lie embodied in Ideals.
Rosette Rozenburg of the Association for Group and Individual Psychotherapy raised the problem of non-ending: how the requirement to keep a training patient for a specified length of time affects the process of the therapeutic work. A training patient that she named Mary, whose life was "infused with losses", demonstrates this conflict. In the analysis of transference, the “effects of loss" present in both the analysand and the analyst were interwoven with this institutional demand: Mary announced that she was leaving one month before the end of the training period. That she actually stayed did not alter the fact that the progress of the analysis was intermingled with institutional contexts. Rosette asks how a patient who is told that the treatment must last at least two years and that it must be of a particular frequency can position themselves with respect to Freud's dictum that “the analytical relation is based on a love of truth". By looking at material from Strachey, Balint, Lacan and the lacanian analyst Leonardo Rodriguez, she demonstrated how different formulations can be given to the conflict that sometimes exists between professional regulations and the judgement, ethics, and desire of the analyst.
After lunch, Alan Rowan of the Centre for Freudian Analysis and Research, in a paper entitled "Psychoanalysis and Healthcare: contexts and dilemmas”, raised the theme of the socio-cultural position of psychoanalysis (and of psychotherapy in general). He described class differentials in access to talking treatment that result from institutional practice in Britain and the United States: giving a formulation to the problem of widening such access led him to pose the prior problem of what it is that psychoanalysis is aiming at. There exists here a wide range of difficulties in the field of existing empirical research and commentaries on the aims of psychoanalysis. Misunderstandings proliferate as general psychologists fail to grasp the nature of these aims, and their implications. Psychoanalysis aims to introduce a new element into the subjective life of individuals that allows them to alter their relation to their symptoms and to their suffering. Such an aim actually calls into question much that has been taken for granted about the nature of a science. Alan quoted Lacan paraphrasing Freud: "psychoanalysis ... may ... enlighten us as to what we should understand by a science". Much still remains to be formulated, let alone resolved, in this area of scientific research and human value. Alan raised the comments made by Martha Nussbaum on formulating therapeutic aims in terms of autonomy, together with her reservation that there does not exist even a plurality of measures which cumulatively can provide some assessment of autonomy. What psychoanalysis is aiming at is not autonomy, but something slightly and insistently different, an aim which moreover accommodates poorly into the networks of demands set by most institutions.
Bernard Burgoyne of the Centre for Freudian Analysis and Research proposed establishing the direction of the treatment by means of the division introduced by Aristotle in his Poetics between the beginning, middle and end of a tragedy. The point of reversal - at which it becomes impossible to maintain any further previous hopes about happiness and pain - separates the first part of an analysis from what follows it. Where the beginning is an articulation of the threads, the point of reversal introduces a discovery concerning who the analysand is, and the continuation - the denouement - is an unravelling of the threads that constitute their history. Freud adopted this aristotelian ordering of the treatment in proposing a beginning, a middle, and an end of analysis. The themes of catharsis, frustration and renunciation allow a formulation to be given of analysis as moving away from impasses in the moral life of the analysand towards a direction where there are pathways through. Lacan formulates this direction as starting from a dialectical rectification of the analysand's relations, and then moving to the transference, and then to interpretation and analysis within the transference. Strachey's proposal for interpretation of the transference, and some forms of kleinian technique reverse this order, putting the middle or the end before the beginning. In this respect they follow Jean-Luc Goddard more closely than Aristotle. Bernard proposed a retranslation of the "shepherding the analysand" found in the English version of Lacan’s Direction of the Treatment. replacing “shepherding” by “channelling", directing the analytic work along the pathways that allow the tragedy of these love relations to be put into words.
The following panel addressed the question of how a concept of the end of analysis affects the direction of analytical work. Valli Kohon of the Association of Child Psychotherapists presented a notion of the symbolic construction of the body image as determining an end aimed at by the analytical work, and in part constructing the organisation of the treatment. She described aspects of her work with a 13 year old boy whose mother had been hospitalised with a diagnosis of schizophrenia when he was three. This adolescent boy was dishevelled, confused and living in a world in fragments. He had accumulated nappies, wires, scissors, knives that he had stumbled across; on his body there were tiny - almost imperceptible - scars. In this state he needed someone who could stand "the chaos and confusion", in order for a thinking process to begin - the beginning of the construction of a body image that was no longer simply "a fragile holed body schema where the unthinkable drains out of the holes". This process of beginning to have a mind that can hold and retain thoughts thus directs the work; theoretical problems of the relation of schema and image, of symbol and symbolic equation, are constructed as the backcloth to this direction.
Lindsay Watson of the Centre for Freudian Analysis and Research presented a case of a young woman in her mid-30s, with two children. In retrospect, her problems centred around gaining access to what it means to have a woman's body, and the obstacles to this present in her relation to her father's look. She has multiple sclerosis, and is struggling hard against fatigue and immobility. Her mother had left suddenly when she was five years old. Her father had forced her mother to dress up, to go out, to pick up and have sex with strange men. After the mother left, he had said he had been "abandoned"; after the housekeeper left, when she was nine, she became the "little wife". A symptom that emerged in the treatment was an obsession with the television: she would become jealous when sexually provocative scenes were shown, and stand bodily in front of the screen, so as to obscure her husband's view. She had done the same with her father after the housekeeper had left; this symptom diminished as more connections were made with the father's look. In her sexual relation to her husband, she had had a vision of her father's head near the bed. She had been unable to face her own genitals, and had only childish names for her genital organs. As the work progressed, she was able to say the word "sex”, and to recognise her own genitals. This reclaiming of her body functioned as an aim for the treatment, and directed its course. Her struggle to escape from this enslavement to her father's look has allowed her to adopt a new language, one that leads to her now becoming less cut off from the reality of her own body.
The final presentation was by Sylvia Cohen of the Guild of Psychotherapists. Sylvia proposed the Jungian conception of self as generative of meaning and direction. In a series of case vignettes, she described the way s in which the analysis must establish a contact with the Collective Unconscious, in order for this search for self to be successful. The direction of the treatment is given by the task of finding one's own path through a movement towards symbolisation within this process of individuation. From a theme introduced by Michael Balint, she stressed the difficulties that have been discovered in establishing an independence from the orientation and style of one's own analyst. The question she left the meeting with was: can individuation free the analysand of the influence of the analyst? It is to be hoped that the third conference in this series will maintain the momentum of this one. Not only was there much to be gained from the presentations and lively debates, but such contexts for argument and discussion are rare and necessary in order to allow analysts to maintain a sense of the direction of their work, and to progress psychoanalysis in Britain.