Abstinence In The Position Of A Psychotherapist

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Withdrawal is a technical principle according to which avoiding the therapist's reward for the client increases his frustration, facilitates the identification, recognition and understanding of the transference neurosis, providing an opportunity for working through and structural change. Many consider the principle of abstinence to be strictly imperative in the work of the therapist and counselor

At the same time, empathy, humanity, and a supportive position are also required. What determines the balance of these seemingly multidirectional forces?

The concept of abstinence was first described by Freud. The general position was that psychoanalytic treatment should be carried out in a situation of refusal of the client to support his positive or negative transference. The logic of his reflections on the principle of abstinence is based on the fact that since a person's refusal to satisfy some desire led to the formation of a neurotic symptom in him, then maintaining the refusal throughout the patient's course of treatment may serve as a motive for his desire to recover.

In turn, the follower of Freud - Ferenczi believed that the childhood of many neurotics passed in an atmosphere of indifference or harsh attitude of the mother to the child. The absence of maternal tenderness was one of the traumatic factors that subsequently affected the neurotization of a person. If in the process of analytical work the doctor treats the patient in the same way as the patient's mother treated him in childhood, depriving him of affection, support and not allowing any indulgences in relation to the satisfaction of certain drives, then this not only does not eliminate early traumatic experiences, but, on the contrary, they become even more acute, severe, intolerable, aggravating the patient's neurotic state.

Subsequently, the idea of abstinence was revised. Most analytic psychotherapists believe that harsh abstinence on the part of the analyst can seriously distort the therapeutic dialogue and contribute to the provocation of conflicts due not so much to the patient's initial psychopathology as to the therapist's rigid attitude.

The latter point of view is shared, in particular, by R. Stolorow, B. Brandschaft, J. Atwood, who proposed replacing the principle of abstinence with an indication that the analyst should be guided by the current assessment of factors that accelerate or restrain the change in the patient's subjective world. This point of view is reflected in their work “Clinical psychoanalysis. Intersubjective Approach”(1987).

Thus, in the modern approach, the Rule of Abstinence includes at least two requirements:

• the psychoanalyst must deny the patient, who is counting on a reciprocal manifestation of erotic feelings, in the satisfaction of his desire;

• the psychoanalyst should not allow the patient to be relieved of painful symptoms too quickly.

In the method of symbol drama, the rule of analytic abstinence in the work of a specialist presupposes, first of all, adherence to a therapeutic "framework" that allows the implementation of the abstinence position. Ya. L. Obukhov-Kozarovitsky notes that in psychotherapy using the symbol drama method, as in any other psychotherapeutic process, a transference and countertransference relationship develops between the patient and the psychotherapist. Feelings of the patient's transfer to the psychotherapist are characterized by the fact that the patient begins to treat the psychotherapist as significant objects from his past.

Most often, the so-called "maternal transference" occurs in symbol drama. Moreover, it can be directed both to a female psychotherapist and a male psychotherapist. The so-called "paternal transference" often develops. If the patient has a special sympathy for the therapist, even falling in love, then they speak of "erotic transference". In psychoanalysis, it is customary to distinguish not only "positive", but also "negative" transference. It is expressed in irritation, annoyance, anger of the patient in relation to the psychotherapist, as well as in the fact that the patient experiences uncertainty, shyness, and indecision in relations with the psychotherapist. Working out transference, countertransference and resistance plays a central role in the analytic process and symbolic drama. In this case, the psychotherapist must comply with the principle of technical neutrality (equidistance to IT, I and SUPER-I), as well as the rule of abstinence. In symbol drama, the psychotherapeutic process is based on supporting and helping relationships (according to Wöller / Kruse).

Thus, we can say that by abstinence it is customary to understand the position of the psychotherapist in which he, observing the basic principles of analytical therapy, maintains personal calmness, does not get involved in the emotional experiences of the client (patient), allowing him to show the whole gamut of feelings. Thus, the therapist and the client himself accept and contain the client's experiences. This fosters the freedom to express the client's “unsafe” feelings in a safe environment, under the guidance of an experienced professional who can help deal with them if required.

These feelings can open for the client himself such aspects of his own personality that were previously inaccessible to understanding. The very energy of experience serves as a "catalyst" for internal changes that are desirable for the client. At the same time, therapeutic contact includes empathy on the part of the therapist, moderate feedback in the form of empathy and empathy. The ability to maintain a position of abstinence with strong empathy is one of the key skills of the therapist and counselor.

In conclusion, one can familiarize oneself with the position of the modern psychoanalyst D. Rozhdestvensky, who suggests, when working with the client's transference, “to leave any attempts to confine the patient within the framework of a certain theory or work with him in a certain technique, and conduct an ordinary conversation with a person, accepting him as he is."

Sources:

1. Editors Burness E. Moore, Bernard D. Fine

The American Psychoanalytic Association and Yale University Press New Haven and London / Translated from English by A. M. Bokovikova, I. B. Grinshpun, A. Filts, edited by A. M. Bokovikova, M. V. Romashkevich. - M.: Independent firm "Class". - 2000.

2. Leibin VM Freud, psychoanalysis and modern Western philosophy. - M.: Politizdat, 1990.

3. Obukhov Ya. L. Dealing with the destructive aspects of transference and countertransference in the analytic process and symbol drama (internet source freud.rf / russia / obuchow1.htm)

5. Ermann M. Method of psychoanalysis - frequency, duration, setting and application in practice // Lindauer Texte (Texte zur psychotherapeutischen Fort- und Weiterbildung) (Hg. Buchheim P., …). Springer, 1995.