shortessays

Prof. Donald L. Carveth
York University, Glendon College
Department of Sociology
2275 Bayview Avenue
Toronto, Canada
M4N3M6

Telephone: (416) 736-2100 ext. 88378 Fax: (416) 487-6850

Psychoanalysis and Values

Anna Freud said the proper posture of the analyst is "equidistant from ego, id and superego." It might be possible to achieve this ideal if the unconscious did not exist and did not leak. But psychoanalysis teaches us that the unconscious exists and that the repressed returns in disguised forms. As an ideal that is, by definition, impossible of perfect fulfillment, that of the neutral, non-judgmental analyst, equidistant from id, ego and superego, is helpful, but only up to a point. For since analysts too possess superegos they will judge, for that is what the superego does. Furthermore, some such superego judgments form a necessary and legitimate part of analytic work. Since judgment is inevitable analysts must choose either to become consciously aware of such judgments or to repress them. If analysts are unaware of their countertransference, the repressed returns in disguised forms, often in the form of clinically destructive enactments. This applies as much to the judgmental countertransference as to any other type. Analysts have especially tended to remain blind to that component of their judgmental countertransference that involves their taken-for-granted health values. When analysts recognizes such health values as judgmental countertransference they are in a position either to contain and not impose or consciously decide to adhere to such values in their analytic work. They are in a position either to attempt to adhere exclusively to the penultimate ethic of honesty and the truth values it espouses, helping analysands become conscious of their values, desires, goals and attendant conflicts, or to consciously decide to take a particular value position in their work. But when analysts fail to recognize their values as judgmental countertransference, such values will likely be unconsciously imposed rather than either contained or consciously imposed upon the analytic process. This is especially likely to be the case with respect to the health values that are very often so taken for granted by therapists that they are not even recognized as value judgments and as part of the moral countertransference that the therapist brings to the treatment. Current attempts to confine psychoanalytic training to mental health practitioners or health care professionals is only likely to exacerbate this problem as more and more analysts come to conceptualize the analytic process in terms of mental health values rather than truth values. This is not to say that health values in general, or mental health values in particular, should not play a part in psychoanalytic treatment, but only to insist that such values be recognized for what they are. If they are brought into the treatment they should be brought in consciously rather than unconsciously.

Freud discovered that we are, at the very least, double (cs/ucs, manifest/latent). People often come to analysis saying and believing they want ... whatever, let's call it A. But in the course of analysis it often turns out that they want something else, maybe something incompatible, as well. Sometimes it turns out that they want non-A even more than they want A. Sometimes a patient arrives saying he/she wants to live, but it turns out that wish is only coming from one part of the patient and there is another part, sometimes even a deeper and larger part, that wants to die. Sometimes patients come saying they want to love, but it sometimes happens that there is another part of them, sometimes a deeper and larger part, that wants to hate. The analyst's job is to help make the unconscious conscious. This means helping the patient realize that in addition to wanting to live, he or she wants to die; in addition to wanting to love, he or she wants to hate. In other words, the analyst's job is to help the patient become conscious of his or her conflicting desires. Then it is up to the patient to decide what to do--to go on living with the conflict (that has now become conscious), or to try to "resolve" it (overcoming paralysis but not ambivalence by affirming one direction over another) and, if the latter, which of the contending directions to affirm. The analyst is entitled to hope that the analysand will ultimately affirm life and love over death and hate, but sometimes this hope is unfulfilled. While analysts must recognize and respect the analysand's right to choose differently, they at the same time have the right to decide what goals they themselves are willing to work toward in analysis. If it becomes clear that my analysand wants to die, this is a goal I will not support, nor will I be put in the position of watching as my patient pursues it. Under certain circumstances, such as a suspected suicide attempt, I will impose my values by, for example, calling the police. Because, for me, therapy is about life, not death, if the attempt was real and the patient survives, I may well decide to terminate the therapeutic relationship, unless the patient convinces me that his or her goal is now to live and solicits my help in realizing this common commitment.

If except under exceptional circumstances we seek not to impose our values, this is not at all the same thing as having no values, for it is a value to value not imposing values. The analyst is continuously displaying his or her core values through his or her commitment to the analytic process and to each particular patient. The practice of analysis implicitly affirms not only the value of self-knowledge, but also that of life and love: the analyst is alive (i.e., has not chosen suicide); he or she is reliably available to work; he or she can be relied on to strive to overcome resentment, revenge and retaliation in favour of both empathic understanding and of continuing the joint project of analysis. In these respects the analyst is not neutral and legitimately so. Not infrequently the analyst's commitment to such values and the attachment that develops between analyst and analysand influences the latter's existential choices.