Marianne Goldberger interviewed Paul Gray before he gave his plenary address, “Memory as Resistance and the Telling of a Dream,” at the 79th annual meeting in New York last May.
MG: Would you tell me something about how your ideas about analytic technique evolved?
PG: At some point in my analytic training I became aware of what seemed to me a puzzling discrepancy: In teaching, analysts emphasized the importance of following the events in the patient's mind; but in clinical conferences, continuing case presentations, and supervision, they frequently showed interest in the patient's behavior outside the analytic situation, an interest I had come to associate with psychotherapy. My attempts to resolve this discrepancy were greatly facilitated when I found support for my own views in the contributions of Anna Freud and Fenichel. Continuing their efforts, I've tried to develop a technique of defense analysis that would attain the most effective access to drive derivatives and in that way facilitate analytic progress. I believe that focusing attention consistently on what happens “inside” the analytic hour helps patients become aware of the many unconscious activities they use to resolve conflict at the time they're using them. This focus provides patients with a vivid demonstration of their defenses in action. Opportunities for analyzing defenses in this way arise in many forms, including the defensive use of memories.
I have found support also in the writings of Ernst Kris and Richard Sterba, as well as in the confident words of Rangell and Brenner. In more recent years, several papers were, of course, important—among them Lawrence Friedman's seminal paper on the tasks of a theory of the mind.
Although theory informs practice, it is also true that theory arises out of clinical observation. For me, this has been increasingly true over the past 15 years. I do a fair amount of supervision, and that enriches my interest in technique and how to teach the gathering of data from what the analyst observes, rather than from what he feels, I believe that in psychotherapy (which I also teach and which I find very interesting) there is plenty of room for resonating sources of knowledge between the patient and the therapist. But in analysis, if you want to take the patient's ego along for the whole journey, it's better to use data that both patient and analyst can corroborate.
MG: Does your emphasis on observing the “immediate present in the analytic hour” mean that you think only transference is important?
PG: No. Although one can more easily observe and demonstrate transference in that context, the crucial issue is that in analysis the intrapsychic necessity for resistance is continual. So the best opportunity for effective insights is in observing and demonstrating the phenomena of conflicts and their defensive solutions by the ego as they occur in the material of the analytic process. Calling attention to these phenomena at the very moment they arise in the analytic hour provides the most convincing illustration of them for the patient (and for the analyst, too). Gaining access to the live “theater” of consciousness is advantageous for productive analytic work, especially for helping the patient to become capable of self-analysis. It's probably true that I give priority to transference of defense, as compared with transference of the id. The reason is that so-called id transferences will more easily reach their conscious manifestations if the transferences of defense are well analyzed first, and that's why I set my priorities as I do.
MG: Does your approach eliminate suggestion?
PG: Hardly. I've explicitly indicated that suggestion can never be eliminated. The spectrum of possible degrees of suggestion is, however, considerable—from hypnosis at one extreme all the way to skilled efforts to engage the patient's rational attention and observation at the other—and I favor staying as close as possible to the latter end of the spectrum. The systematic analysis of the transferences of authority, as manifested in the reexternalizations of the ego's superego function, will make analysands less susceptible to the power of suggestion and allow them to perceive external and internal reality more accurately. In fact, analyzing the transferences of authority will reduce the patient's susceptibility not only to suggestion, but also to other irrational influences. That's why I feel it's so important to develop technical approaches that diminish the use of suggestion. Of course, you would not agree if you believed that it's all right to bypass the rational ego, which is what suggestion does, or that it's even advantageous to do so (as is often true in psychotherapy). After all, even hypnotherapy has its serious adherents, and practitioners in that area are much more sophisticated today than in Freud's time.
“… If you want to take the patient's ego along for the whole journal, it's better to use data that both patient and analyst can corroborate.”
MG: Some people object to your preference for analyzing the superego as a defensive measure of the ego, since patients often defend against the manifestation of superego activity. How do you respond to that?
PG: I don't see any problem there. The ego can regularly defend against any painful affect—that's the nature of the “unpleasure principle”—even when the ego itself has initiated the pain out of some previous defensive or resistance need.
MG: But you're not addressing the issue of unconscious guilt.
PG: First of all, I think it's practical to regard the affect of guilt as something the ego does to reinforce restraint of conflicted drive derivatives. I'm referring here to conscious affect; the idea of unconscious affect is not very convincing to me. The concept of an “unconscious need for punishment” may be useful to account for the behavior of everyday life, but in the analytic process “punishing” affects are evidence of the ego's efforts to reinforce the resistance against the emergence of drive derivatives.
I think the same is very likely true for all painful affects in the analytic process. If the patient is feeling guilty about something during the analytic
hour, the primary purpose of that painful affect is not to punish for an act in the past, but to provide immediate reinforcement against any repetition. Such reinforcement frequently includes measures of “turning against the self.” The painful affect heads off any instinctual gratification that manifested itself previously and now in the analytic moment is threatening to emerge again.
To push this idea still further: In everyday life, the labels guilt, shame, embarrassment, and humiliation are all usefully applied to phenomena that assure more civil behavior, but in the analytic situation, civility is not a requirement of behavior. Likewise, the purpose of rational or “appropriate” communication in the analytic situation is not to enhance civility, but to enhance the effectiveness of the communication. I have no disagreement with thinking of all the ego's “moral” responses as compromise formations. My point is that the special requirements confronting a patient in the analytic situation tilt the patient's ego function of balancing drive against defense clearly to the side of the defense. From the moment the analysand understands the goal of exposing “everything,” resistance becomes the ego's highest priority and it stays there throughout the analysis.
MG: Is the claim that you tend to neglect dreaming an unfair one?
PG: Maybe all's fair in questioning someone else's—and one's own—ideas. I have no problem with our theory of dream formation; it involves compromise formation, just as symptom formation does. I emphasize paying attention to the patient's telling of a dream, to the dynamic implications within its content, and to where it occurs in the hour. My stress, in the analytic situation (though not necessarily in analytically oriented psychotherapy), is observation of the intrapsychic reality of the moment in the hour, as compared with external realities.
MG: Doesn't your technique limit what you perceive in the material?
PG: I hope it does. In every variation of listening to or perceiving analytic material, the analyst must choose some perspective on the material, usually on the basis of his conceptual orientation for analyzing the data. I'm aware that some practitioners claim to approach patients without any theory or technique—I have in mind some of the self psychology proponents, who say “just listen and learn.”
I'm also aware that an early description of analytic listening used the term “free-floating attention,” by which Freud meant to emphasize the possibility of contact between the patient's unconscious and the analyst's unconscious. Even though one can achieve such resonance with free-floating attention, some things are left out—the unconscious operations of the ego, for example The idea of free-floating attention was formulated by Freud long before he grasped the structural concept of the ego and its implications for the role of anxiety. Making all the mind's unconscious structures conscious was a goal that could not be conceptualized at that time.
“… one must not become so intrigued with id manifestations that one cannot work with what is taking place nearer the surface.”
The particular perspective on analytic material that I write about is merely a more specific version of Anna Freud's recommendation that in order to include the analysis of the ego it is necessary to have “a change of focus.” Such a change of focus certainly does not exclude uninterrupted attention to id derivatives in the material, an essential hallmark of analytic listening. But observing conflict in close process is a more demanding task than the essential one of merely noting drive derivatives. I see acute sensitivity to id derivatives as the prerequisite for noticing where in the flow of the material these derivatives encounter conflict and where the ego then deals with them in a variety of ways in order to relieve the edge of anxiety or other painful affect that signals an approaching danger.
My emphasis is on derivatives that have intruded slightly into the patient's conscious material. And I choose those derivatives solely because the ego's subsequent resistances to them can be demonstrated to the patient. In making this choice one can hardly avoid being aware of underlying levels of instinctual elements. The id is unquestionably fascinating (for both the patient and the analyst), but one must not become so intrigued with id manifestations that one cannot work with what is taking place nearer the surface. You could claim that that is “limiting what is perceived,” but I prefer to characterize it as choosing to keep the microscope focused at a level of action that can more likely be shared with the patient's observing ego.
MG: Some analysts have said that when they apply your technique patients feel they are being nagged.
PG: I assume that those analysts are not referring to patients who regard any comment of the analyst as “nagging,” but if that's not the explanation, then I would look into how the technique is being applied. For example, the patient may feel nagged if the analyst's observations about conflict and defense make the patient feel responsible for having “gone and done that again.” Defense-oriented interpretations that start with “But you didn't say anything about…” often sound to the patient like nagging. In any case, such interventions are not helpful because they show the patient nothing about the when and the why of the defense.
The analyst must pay careful attention to the tone and wording of defense interpretations so as to engage the patient's curiosity, and this can be done only when the patient does not feel wounded. For example, any repetition of a familiar observation may be perceived by the patient as nagging unless it is offered with sensitivity and with appropriate variations in the precise wording. In fact, the analyst needs to develop an appropriate repertoire for applying the technique I've suggested—a repertoire free from judgmental words and tones. But if a patient feels criticized even when analytic observations have been expressed with these qualifications in mind, one need not conclude that something is lacking in the technique. A more likely explanation is that some important character trait of the patient is responsible. And, of course, the character trait itself becomes a subject for analysis.
MG: Some of those analysts also say that such close observation of the moment-to-moment events in the analytic hour lends itself to joint obsessional thinking.
PG: The purpose of focusing attention on the moment-to-moment events in the hour is to hold the analytic process close to what the patient is actually experiencing. If that leads to increased unconscious defense (“obsessional thinking”), then the method is being misused. Any analytic technique can lend itself to intellectualization if the analyst is so inclined. The whole point of focusing on the immediate moment is to help the patient know how, when, and why he uses defenses. In this way, the patient can eventually choose whether or not he still will use these
(formerly unconscious) means to ward off affect-laden mental contents.
MG: In summary, would you say how your approach differs from that of so-call classical analysis?
PG: There are two different emphases in strategy. First, I pay particular attention to those drive elements that intrude into the conscious field and encounter conflict, with the result that the ego's defenses remove those elements from consciousness. These are psychic events demonstrable to the patient and subject to analysis. You can see how this approach differs from the “classical” one, in which deduced evidences of not yet conscious drive derivatives are the subject of interpretation.
The second difference in strategy concerns reconstructions of the initial circumstances in the patient's childhood that required the use of ego defenses. Whereas the emphasis of classical reconstructions is to pinpoint the existence of specific infantile instinctual interests, the aim of my reconstructions is primarily to identify how and why the ego brought defenses into play against those specific interests.
In addition, there are two tactical differences. First, this approach pays significantly closer attention to the moment-to-moment, sequential flow of associations than does the classical method. This tactic requires a form of attention more complex and demanding than “free-floating” attention alone. Second, I assume that right from the beginning of an analysis, the patient invests the transference with the reexternalization of the internalized images of authority. Because these images have a history of helping to reduce the dangers of conflicted instinctual derivatives, they reappear in the transference to facilitate resistance. I stress the importance of analyzing these transferred superego functions of the ego, whereas the classical method leaves them largely in place to empower the analyst to help the patient to overcome resistances.
I want to emphasize that I apply these techniques only with patients whose psychological potential permits a consistent and extensive focus on the analysis of resistance. For patients who are unable to allow increasing ego participation, even though given an extended opportunity to do so, I recommend reverting to a more traditional interpretive approach or using analytically oriented psychotherapy.