A Fresh Look At Psychoanalytic Technique

After reading and being enamoured with ‘Creating a Psychoanalytic Mind’ by Fred Busch, I was eager to read, and to invite my colleague to read and review another Fred Busch book, ‘A Fresh Look at Psychoanalytic Technique’. Fred Busch’s explanatory style and provision of examples to explicate his points make his writing a pleasure for me to read. What Fred Busch offers to me is very containing; a ‘northern light’ for being with my patient’s, amongst the myriad of theories and schools in not only psychoanalysis but the psychiatric and behaviourist traditions.

In this book, A Fresh Look at Psychoanalytic Technique, Busch acknowledges the growth-enhancing and always growing knowledge offered by different perspectives within psychoanalysis. At the same time he acknowledges that the collective aim, regardless of perspective or school, was to “open up spaces in a patient’s mind that were previously closed off, and in this way we help them re-find their mind” (p.4).

To create a “psychoanalytic mind” (p.7), Busch integrates theoretical developments in the application of technique including the thinking and work of Ferro, A., Steiner, J., Bribing, E., Gray, P., Joseph, B. and Green, A. Busch applies the “change in focus from working directly with the unconscious and searching for what has been repressed, to the general recognition across theoretical perspectives that is it important to work more closely with what is preconscious, and the emphasis on building representations of what was previously un-thought, or under-represented, as well as what was repressed” (p.7).

Busch highlights the task of making our interventions more understandable and emotionally meaningful to patients. He does not want to “confront patients with what the analyst gleans from the patient’s unconscious”, instead he works “more closely with what the patient is able to hear, understand and potentially integrate” (p.7).

In chapter two, titled, Psychic Truths Busch provides the following example which highlights this:

“A patient began a session talking about how he enjoyed riding his motor scooter to his session in the summer. He loved being out in the early morning air, and he felt more able to look around and appreciate the scenery than when he drove his car. His thought then turned to the danger he sometimes felt when cars passed too close to him. I said to him “It seems to me you’re saying that to do something you love is dangerous”. Busch notes “I could have made a more specific interpretation about how the patient was experiencing the danger of his loving feelings towards me, or his homosexual anxiety”, and believes “these statements would have been correct enough”, “however, this occurred at a point in the analysis when any direct interpretation of the transference that I made caused his mind to freeze. While this in itself was significant, it was not helpful to continue interpreting directly in the transference. Thus, I felt that working in this more unsaturated fashion gave the patient the best chance of opening his mind in a way that was acceptable to him”. Busch then explains his use of ‘it seems’ to begin his observations with. “In this way, I conveyed the idea that this was my impression of what he was telling me.” “Over time I have found that, by talking about my impression of what is going on – rather than telling the patient, “this is what is going on-I can give the patient greater freedom to disagree and to follow her thoughts rather than mine” (p. 31).

Busch described the need for analysts to interpret “in the neighbourhood” of what the patient is capable of hearing, which he facilitated through the notion of “the workable surface”. This workable surface is that which lies between what the patient thinks is on their mind, and what the therapist thinks this means, in order to limit ‘stopper interpretations’ and patients ‘identifying with the analyst’s functioning’. Busch explains this and how he maintains the balance between close process monitoring of resistances and their analysis, and the privileging the patients experience of their own thoughts and feelings, and participation in the process and their capacity to integrate interventions.

Busch remained connected throughout the book, to the meaning of the ‘vitality of our profession’ i.e what it means to be human and the therapist’s role in setting in action a creative process within the patient.

The book is actually a compilation of various papers that Fred Busch has written and which have been published in a number of psychoanalytic journals. He methodically articulates and explains the thesis of each chapter, in a way that facilitates a connection with and understanding of, in a very alive way his understanding of what he does and why.

Busch emphasises the slow methodical process inherent in psychoanalytic work, his intent and focus on the manner and form of the patients’ communications, elucidating defenses as they’re witnessed in operation, and articulating them to the patient in a way that the patient can understand and connect with. Busch seemed to keep asking himself ‘what can the patient hear, understand and integrate? How can I facilitate the patient’s self-observation and self-reflection?

Busch reinvigorates and enriches thinking about and implementing concepts such as ‘in the neighbourhood’ (a concept from Freud’s (1910) paper, ‘Wild psycho-analysis”), ego resistance, free association, interpretation and deep interpretation, and psychic truth. In regards to psychic truth he reminds us that the search for truth is in itself therapeutic, as opposed to finding the truth, with the analyst attempting “to create the conditions in which insight is possible, rather than giving insight per se”. Busch notes that finding key stories is more about identifying opportunities “to enable a deepening understanding and a readiness to understand old stories in newly configured forms, as well as the freedom to identify new stories”.

From my perspective, the book would be excellent for students of psychoanalytic psychotherapy, and for early career psychoanalytic psychotherapists who may find themselves feeling constrained and burdened by their training. I would have liked to have read many more examples of Bush’s interactions with his patients, having relished the one’s provided.

Busch’s examples, metaphors and analogies brought a meaning and aliveness to his writing on technique that we found highly engaging. Both of us have been and remain interested in the details of technique and its ongoing development, and Fred Busch has certainly delivered.

Reviewed by Michele Dykman and Vicki O’Dwyer,
Graduates of the Victorian Association of Psychoanalytic Psychotherapy intensive training in Adult Psychoanalytic Psychotherapy.