Chapter 7. Different Types of Anxiety and Their Handling in the Analytic Situation (1978)

This paper was presented as part of a Dialogue on ‘Different types of anxiety and their handling in the analytic situation’ at the 30th Congress of the International Psychoanalytical Association, Jerusalem, August 1977, and was first published in the International Journal of Psycho-Analysis 59 (1978): 223-8.

In this discussion on different types of anxiety and their handling, my approach will be primarily clinical. I want to start by looking at the way in which patients use us — analysts — to help them with anxiety. After all, the reason which brings patients into analysis is fundamentally that they cannot manage anxiety, though it does not, of course, mean that the patient is consciously aware of this. Following Freud's structural approach and his work, Inhibitions, Symptoms and Anxiety (Freud 1926) we would now give the notion of anxiety a central position in our psychoanalytic understanding and the search to discover it and to understand its nature, a central role in our day-to-day work. I think that technically we listen to what our patients are telling us in the sessions in terms not of ‘what does this mean?’ but ‘what is the main immediate anxiety here?’ And we start from there in the belief that the immediacy of the transference situation will keep us in contact with the most important anxieties and that we can learn about their nature in this way.

If we start from a clinical fragment — patient A. begins a session by telling me that once again he has been extremely nasty with his wife on the previous night and he enumerates a series of apparently unkind, intolerant things that he has done and his wife's responses. It sounds from this that he might be experiencing what we could call superego anxiety — guilt about what he has done and a desire to get the analyst to understand and explain the reasons for his behaviour. Or he might be speaking about his anxiety about his wife and her ruthlessness and the bad state of the marriage; that is, is it depression, sorrow,