The Establishment and Disruption of the Psychoanalytic Modus Vivendi

One prerequisite for the success of a psychoanalysis is that the patient have the sense that the analyst is trying to be helpful. In his endeavours to be helpful, the analyst will try to create an analytic climate wherein his patient can regress; he will desire that the patient make him the object of his repressed wishes; he will interpret to the patient the nature of his hidden wishes and the various motives he has for avoiding experiencing his wishes; he will hold out to the patient the possibility of discovering more adaptive ways of expressing what has caused him distress in the past. It is not remarkable, then, that various of the analyst's activities designed to promote this intricate series of events lead to contradictory views of him in his patient's mind, in not all of which is he seen as helpful. It is also not surprising that the patient will try to establish a modus vivendi with the analyst whereby he maintains a view of the analyst as a helpful figure but resists becoming more involved in certain of the ways that the analyst considers helpful for the analytic process. This issue is the major subject of this paper. I will discuss the question of how the analyst can best present himself as helpful and be actually helpful at those times when he feels it is necessary to disrupt a modus vivendi which has evolved out the complex reactions that the patient has had to his efforts to be helpful and which interferes with the deepening of the analytic process.

Friedman (1969), in an article on the therapeutic alliance, discusses some of the difficulties that are posed by the patient's reactions to the analyst's early efforts to be helpful. Friedman recalls that Nunberg (1928) had stressed the fact that the basic aims of the analyst are opposed to those of the patient. Nunberg emphasizes that no matter how unobtrusively the analyst presents himself, the patient, during the early phases of the analysis, wants not to be helped but instead desires to fascinate t