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It is always a pleasure to read a new book by Fred Busch, a prolific writer and contributor to psychoanalysis, who has developed a focused point of view regarding analytic technique, based on ego psychology. This book, writes Busch, extends ideas he presented in a previous book , “Creating a Psychoanalytic Mind.” One way to think about his approach is by asking three interrelated questions: What does Busch think is “wrong” with his patient; what would be mutative (hence, his title), and, finally, what is the analyst's role in “cure”?
What is wrong? Patients “suffer from insufficient representations” (p. 10), leading to “a way of thinking and feeling that drives a person in a particular direction,” (p. 10, Busch's emphasis) and weakens the patient's ego. Representations can be more or less “saturated” or “unsaturated” and more or less complex. “Saturated and unsaturated representations have to do with the degree that an unconscious representation is filled with ideas and feelings that bring the person to a single conclusion. Thus, an unsaturated representation would be characterized by multiple ideas about a particular object, while a saturated representation would lead a person to a singular view of the object” (p. 20). Building more complex and more unsaturated representations builds structure and helps a patient contain conflictual feelings. Busch situates this emphasis among many psychoanalytic theories that move from lifting repression to transformation. “That is, rather than primarily searching for buried memories, we attempt to transform the under-represented into ideas that are representable” (p. 12, his emphasis).1
How are these representations transformed? Busch believes that many analysts have focused on what he terms “state” knowledge, which refers to helping patients learn what they have repressed. For Busch, “the process of knowing is as important as what is known. It is my underlying thesis in creating a psychoanalytic mind that what is accomplished in a