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“transformations,” where the sense of an absolute emotional truth can be facilitated to emerge– a change in form–often understood as unborn parts of the self coming into life. Some recent papers concerning the setting, link the temporal and spatial aspects of the external setting with the internal setting of the analyst in order to discuss the ways in which the setting represents the earliest level of maternal holding and presence. Many of these papers on the setting/frame take up Bleger’s focus on the unconscious meanings of the frame for the analyst and the patient, using Bion’s concept of the container/contained model of object relationships and the Barangers’ concept of the analytic field. (Barangers, 2008, Civitarese, 2008, Churcher, 2005, Green, 2006).
II. EXTERNAL SETTING
Space : the couch . Freud made the following recommendations: “he invites them [patients] to lie down in a comfortable attitude on a sofa, while he himself sits on a chair behind them outside their field of vision.” (Freud 1904, p. 250). There are several reasons for Freud to make this suggestion. Historic reasons: In the clinical cases in “Studies of Hysteria”, Freud notes that patients he visited were frequently lying on a sofa or couch, and that they preferred to remain in that position, especially if they closed their eyes to talk about their ailments. Later, he adds a subjective motive for avoiding the face-to-face position: the feeling of discomfort and lack of freedom when being observed by the patient. But he gives other reasons: “[…] [the patient] is spared every muscular exertion and every distracting sensory impression which might divert his attention from his own mental activity” (Freud, 1904, p. 250). And for the analyst: “Since, while I am listening to the patient, I, too, give myself over to the current of my unconscious thoughts, I do not wish my expressions of face to give the patient material for interpretations or to influence him in what he tells me.” (Freud, 1913, p. 134). After a hundred years, accumulated experience allows us to consider those recommendations as valid. The use of the couch to facilitate the patient’s focus on his mental activity implicitly allows for psychic regression, which enables the expression of unconscious phantasies and conflicts to emerge within the network of associations. Winnicott (1955) understood the analytic setting as providing the conditions in which developmental disturbances arising from developmental failures and traumas could be expressed, met and interpreted so as to allow for developmental progression. (See below, Setting and regression ). Time. This consists of sessions lasting 45 or 50 minutes; a high frequency of sessions between three and five per week; and although the duration of the whole treatment is difficult to determine, as each patient will require a particular period, it is known that this usually involves many years. As greater understanding of psychic life, particularly concerning primitive and psychotic levels in all patients, has been achieved, the duration of psychoanalysis has become longer.
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