Back to Table of Contents
there may be a need for a ‘new’ object relationship, including a flexibly active inquiring interactive approach before ‘frozen-withdrawn’ depressed patients ‘warm up’ to free association. Active inquiry might be within the purview of Gray’s close process monitoring (above) of what triggered the ‘freezing-withdrawn’ response, as much as in the purview of the interpersonal approach of Theodore Dorpat (below), where asking a question indicates an interest on the part of the analyst as the real person within a new ‘real relationship’ with the patient. This may firm up the increased need for trust, safety and object constancy with the analyst (Kramer & Akhtar, 1988) before free association can resume. It is, however, notable that sometimes even those who advocate modification of technique as adjusted for the patient’s condition, concomitantly uphold that, on the overall, “Good therapy can only be done through the patient's “free association,” when he is encouraged by the analyst to express his transference feelings about the analyst without fear, whatever they are” (Lorand 1972). III. Baa. Introduction to Multiply Dimensioned Contemporary Scene An introductory example of the qualified use of free associations along multiple criteria is the contemporary inclusive Freudian perspective of Harold Blum . From this perspective, object relations are a necessary precursor and a foundation for psychic structure formation within the tripartite structural theory. Reviewing the evolution of free associations within the larger context of the evolution of psychoanalytic theory and clinical practice (Freud 1895, Anzieu 1986), Blum notes that “…discoveries of dream psychology, unconscious mental processes, the psychoanalytic process, and the basic analytic technique of free association and interpretation were closely interwoven” (Blum 1996, p.520). In a series of publications between 1976 and 2016, Blum addresses free association in relation to both ego functions and object relations, in relation to dreams (1976), interpretation (2016) and reconstruction (2019), qualifying the instruction concerning, and use of, free associations according to a number of specified conditions and criteria, including capacity for controlled regression, reality testing and other ego functions, quality of object relations, and transference-countertransference field manifestations. In a contemporary reformulation and specification of Freud’s (1938) delimiting the use of free associations to non-psychotic individuals, Blum reaffirms that experience has shown that supportive psychotherapy is usually preferable for psychosis and for severe borderline regression. Especially patients with a thought disorder may exhibit free incoherent associations or word salad. Medication may restore some coherence and affect regulation, supporting the therapeutic alliance. Free Associations are never fully ‘free’ of external ‘intrusions’, history, current issues in the patient’s as well as analyst’s life circumstance, and extra-transferential events e.g. third- party payments, pregnancy, birth, marriage, divorce, re-marriage of either partner of the
386
Made with FlippingBook - professional solution for displaying marketing and sales documents online