A “Neuropsychoanalytic” Treatment of a Patient with Cocaine Dependence

Although the use of neuroscience facts in psychoanalytic interpretations appears to be a widespread activity, it is not clear to some analysts how neuroscience is used in treatments. A specific case example of the common psychopathology of addiction is given with a retrospective review of verbatim notes from the first 60 hours of a 5-day-per-week treatment. It is acknowledged that it may be difficult to precisely categorize each interpretation, but the overall impact of neurobiology on the associations of the patient and the interpretations of the analyst is demonstrated. A counterexample from Kernberg (2007) is cited to show how knowing and using neuroscience leads to differing formulations and interpretations than when the analyst uses a purely idealist approach. The use of neuropsychoanalytic interpretations of motivations that must be unconscious by virtue of their origin in midbrain structures is contrasted with cognitive-behavioral treatment for cocaine dependence that uses a learning-teaching model. A neuropsychoanalytic treatment is not reductionistic by insisting that neurobiology is the only possible way of thinking about the exchanges between the patient and the analyst. However, by anchoring the model of psychopathology in material reality, it avoids an idealist drift away from science and allows the possibility that testable hypotheses will emerge from empathic observations. Use of neuroscience in psychoanalytic treatments takes advantage of the origin of Freud's model to preserve its virtues and extend its range.