Meetings of the New York Psychoanalytic Society

March 28, 1979. UNCONSCIOUS FANTASY AND THEORIES OF CURE. Sander M. Abend, M.D.

Patients' unconscious fantasies about the curative process influence the course of the analysis, and understanding the childhood origin of the wishes expressed in these notions of cure is a significant part of the analytic work. The analyst's conduct of analyses is influenced by particular theories of how analysis effects a cure: these theories too can serve to express childhood instinctual wishes. Self-analysis of these contributing forces can aid the analyst in being aware of deviations from optimal analytic understanding and technique. In considering the relationship between unconscious fantasy and scientific theory, Dr. Abend pointed out that although we expect the formation of any theory to be influenced by infantile wishes, the validity of the theory can be ascertained only by examination of its relation to the phenomena it is intended to explain. The theory is not invalidated by identification of unconscious forces influencing it. However, we know from our clinical work that the process of rationalization of one's own ideas can be a powerful source of distortion, particularly when the unconscious wishes are hidden from view.

Dr. Abend described two cases which demonstrated the influence of such theories of cure and their relation to unconscious wishes. A young man's unusually sustained curiosity about how analysis worked was first understood as a transference of the adolescent wish for sexual enlightenment at the hands of a knowledgeable man. This served to deny the patient's fear of and rivalry with his father by substituting a love relationship. Later in the analysis his view of the analyst as "warm and earthy" led back to his recollecting the same wish for sexual initiation from a "warm and earthy" childhood nanny. The analysis of these fantasies and wishes led to an understanding of the patient's most troublesome conflicts. A second patient had a cathartic theory of