“What Does Not Change”: Technique and Effects in Psychoanalysis

What does not change is the will to change.

In an interview with The Daily Telegraph (Copping, 2008), the British analyst Darian Leader expressed concern about recently proposed state regulation of psychoanalysis thus:

The new system may be OK for people like cognitive therapists, who concentrate on trying to get rid of things like depression or eating disorders in a certain number of sessions, but psychoanalysis does not have such set outcomes. Our approach is that we don't know where we are going to go, or how long it will take, we just have to see what emerges. It is an exploration of one's history that, unlike things like cognitive therapy, doesn't aim at the removal of one's symptoms.

Leader's comments are scandalous in their candor: there is not even a pretense of satisfying the expectations of empirical medical discourse, in which a therapeutic technique is judged to be efficacious based on its ability to eliminate symptoms. To say straight out that psychoanalysis “doesn't aim at the removal of one's symptoms” invites the immediate response of “then what good is it?”

While the proposed regulations were ultimately dismissed by court order (UK Government, 2011), Leader's comments leave questions in their wake that go far beyond the immediate concerns out of which they arose. If “we just have to see what emerges” in analysis, and if the therapy “doesn't aim at the removal of one's symptoms,” then what are analysts doing, and why are they doing it? It is striking that these questions remain so compelling today, over a century after psychoanalysis was invented. What constitutes the profession of psychoanalysis? Is it a technique for a particular kind of therapy, for a particular kind of problem? What effects can psychoanalysis be expected to produce, and how does it produce them? Freud addressed these questions—the relation between profession and practice, technique and effects—early on.

Alarmed by what he saw being done in the name of