When I chose this title for my paper I was aware that it might well be viewed as an attack on certain concepts considered to be core to psychoanalysis, that some analysts accept as unquestionable, the received wisdom that was impervious to change, and as such would be rejected outright as more or less tantamount to the sacrilegious. For instance, since I do question the need for free association, the linking of present day problems to their origination in early object relations (as in always making attribution to an earlier deeper explanation of a current emotional response or fantasy), and the use of theory so distant from observable phenomena of development, to name just a few, I expected disagreement. I knew that I was treading on some difficult aspects of clinical work that might offend some readers but I did hope for responses that actually answered my assertions with something more than highhanded dismissal. My many years of practice had led me away from much that had been considered core concepts at the Institute where I trained. I assumed that those who, like me, had attempted to apply psychoanalytic theories to their work with patients would also have evolved in the direction of understanding the supra-ordinate role of the relationship in determining the effectiveness of any psychoanalytic treatment. My plea was for a small measure of skepticism about attempts to keep a hermeneutic definition of psychoanalysis, where analysts armed with their special theory or group of theories pressed their patient onto a not very comfortable bed of their preferred theory. What I hoped for was acceptance of the idea that psychoanalysis should, over a century of practice, evolve so that even technical assumptions such as anonymity, neutrality and abstinence could be questioned as remnants of the past that actually interfered with the necessary relationship that I found was at the core of any significant therapeutic action and effectiveness.
It seemed to me self-evident that clinical experience would not only allow but would require that original concepts dating back to Freud be re-examined, re-appraised and even dropped from the requirements that every analysis was supposed to meet in order not to be dismissed as this isn't psychoanalysis. Unfortunately, the commentaries on my paper reveal the opposite of the kind of openness to even the idea of change that I had hoped for. Perhaps this is related to the critiques of my paper coming from psychoanalysts residing in countries other than the United States, namely Spain and Israel. The openness to change that Glen Gabbard described in his remarks to the recent meeting of the American Psychoanalytic Association on Zoom is nowhere to be found in what I read.
While I appreciate the detailed critique of my paper offered by Cecilio Paniagua, M.D it is impossible not to feel his close reading of the clinical and theoretical issues I raised was in the service of either belittling or dismissing the serious nature of its content. At least he does begin by offering some encouraging words of praise: “Friedman displays a broad knowledge, and intelligent synthesis of the most important psychoanalytic theories.” But it is all downhill after these few positive words. While he does ultimately seem to agree with my response to Wallerstein's view that psychoanalysts with widely differing theoretical orientations do not, in fact, treat their patients in anything resembling a uniform or even similar fashion, he dismisses my elaboration of ego psychology and Kleinian theory: “In his critical remarks this author (Friedman) seems to be looking at some aspects of prior approaches through a magnifying lens, making straw-cases out of their theoretical tenets.” By claiming that in the way which I describe various versions of psychoanalysis I am constructing strawmen (“straw-cases”) Paniagua employs a methodology utilized by apologists for the restrictions of classical psychoanalysis who learned to dismiss new innovations, such as empathy in Self-Psychology, by claiming that it had always been present in their actual functioning in the consulting room. If I am guilty of mischaracterization of various theoretical schools, as Paniagua claims, then the content of my critique can be dismissed, as he does, as the ranting of someone whose reality testing is inadequate or even deeply flawed.
Again, Paniagua seeks to ignore or actually obliterate my position when he writes:
“Friedman finds fault with the genetic viewpoint of classical technique's “insistence” that life problems are “only” manifestations of conflicts originating in oedipal or pre-oedipal positions, thus losing “its relevance to actual patients.” This assertion I found somewhat caricature-like, for I think no analyst of any stripe has ever been able to work competently without due consideration of the post-oedipal circumstances of his/her patients…”
Apparently, he is unaware of the position firmly advocated by no less an influence than Charles Brenner, who insisted that analysis could only be defined by the exploration of infantile sexuality and aggression and that everything else could be regarded as noise and irrelevant to actual psychoanalysis. I would suggest that any critical description of a major theoretical school of psychoanalytic theory will inevitably sound like an unfair characterization of that school to any clinician who sees themselves as following that particular theoretical orientation. The best explanation for this is the probability that no matter which theory a psychoanalyst believes he or she is following, their actual work with any particular patient will reflect much that is true of them as individuals who know that when a patient's need requires deviation from the prescribed theory it is the patient's need that they will respond to. Writing about psychoanalytic theory is very different than practicing within a particular theoretical system. Furthermore, it is commonly observed when talking to former patients of traditional analysts that they remembered very little about interpretations of their unconscious conflicts and much about instances of the analyst's spontaneous kindness and helpfulness.
Zvi Lothane takes a direct approach to attacking the content of my paper. Apparently, any questioning of free association as a barrier to true relatedness between analyst and patient is shocking to him. At least I am in good company, as he links his disbelief and shock at my view of free association to that of Irwin Hoffman, an analyst who I have admired for many years, primarily because of his ability to question the ritualistic aspects of classical psychoanalysis. Lothane turns to authority in order to support his outright rejection of what I write about the alienating and distancing impact of the often-used directive, from analyst to patient, to simply and compliantly say everything that comes to their mind while lying on the couch (or by extension sitting in a chair). By naming and mobilizing the names of prominent analysts who have been dedicated
to free association he can relieve himself of any obligation to actually respond to what I have argued. Ernst and Anton Kris and Isakower, as well as his own papers, are cited as proof that he can simply ignore my critique of the use of free association as an absolutely necessary component of psychoanalytic technique.
In “Psychoanalysis as the Tower of Babel” Erlich manages to combine his misunderstanding of my paper with an opportunity to promote the success of psychoanalysis in Israel. He insists that the shortage of patients on the couch is entirely the product of conditions in the United States. In Israel, he informs us, there is no such shortage, of either candidates or patients. Many applying to be candidates are refused admission for training and one gathers those who become graduate analysts are likely to have full schedules of patients on the couch. The relatively small numbers involved in Israel as well as the issue of fees and whether or not these are paid by national insurance remains unclear. He incorrectly characterizes my questioning of Klein's theoretical ideas, and finds me guilty of having “a need to simplify unbearable complexity in favor of direct observation.” My assertion that Klein's “baby” defies the biology and physiology of actual infancy because there is no brain development sufficient to support the many fantasies that Klein and her followers insisted occupied the infantile mind is somehow seen by Erhlich as calling for direct infant observation. It's as if he is thinking I am calling for infant-mother research rather than the simple fact, with no simplification, that Klein, a non-medical psychoanalyst, brought her fertile imagination to observations of what she conceived to be the infant's mind, imagined by her mind rather than by anything that could or can be verified. Erlich seems to believe that all theory is only theory, hence without any possible claim of being realistically correct, hence we must accept the inevitable differences between competing theories without attempting to examine or critique theories of the mind that are experience-distant and potentially not only inaccurate but harmful to many patients. While he correctly describes the current condition of psychoanalysis that allows for “different theories, which are indeed incompatible, (to) can coexist and be practiced” he favors the position of Rachael Blass, an adamant Kleinian, who has openly resisted the idea of analysts picking and choosing from Klein and adding concepts to their own theories of the mind.
I suspect that Erhlich is a purist, most likely like Blass, of the Kleinian variety,
who is offended by my critical view of the impact of Kleinian theory because it is the product of a speculative fantasy about the content of an infant's mind that exceeds physiological possibilities. His argument that such objections to a theory are unfounded because its usability is all that matters ignores the fact that the result of the theory is profound when it comes to work with patients in analysis. If it can be accurately said that classical Freudian analysis focused on the sexual and aggressive drives in the unconscious and the defenses against them, then we can also say that the Kleinian approach focuses on internalized objects, both good and bad, with the result of making anyone in analysis seem inevitably stuck in either of two positions, the paranoid schizoid or the depressive, both supposedly very deeply hidden in the unconscious but both signifying a level of disturbance that, in my opinion, is imposed upon the patient, whomever they might be and however well they might function in their lives. Finally, I would continue to insist that experience-distant theories are always used in the service of distancing the psychoanalyst from a real relationship with a patient who is inevitably seen as the product of drives or fantasies that are to be studied by the analyst, who can either find the hidden drives or receive the projective identifications of bad objects rather than experience the character of the patient as it interacts with the person and character of the analyst. One way or another, patients frequently find the humanity of an analyst as what really has moved them along on the journey towards a more vigorous self even when the analyst has done their best to maintain excellent technique in order to conceal their real self. The message of my paper, while critical, has always been aimed at saving analysis from failing to convince the educated public that it has greater therapeutic capacity than competing therapeutic modalities. It is this failure, along with economics and the educated public's mistrust of psychoanalysis, that may be the cause of the many empty couches in the United States. I believe that the conditions in Israel may, with time, catch up with those in the United States where most analytic couches are too empty and are likely to remain so unless psychoanalysis reforms and reformulates itself along the lines that I have enumerated.