Alan Bass
The Work of Psychoanalysis: Play
Psychoanalysis as a therapeutic method is strangely a form of work indissociable from play. The theme of work is a constant for Sigmund Freud, and has many manifestations. Yet, in one of the most famous general statements about psychoanalytic treatment, Donald W. Winnicott claims that the work of the analyst is play: “psychotherapy is done in the overlap of the two play areas, that of the patient and that of the therapist. If the therapist cannot play, then he is not suitable for the work. If the patient cannot play, then something needs to be done to enable the patient to become able to play.”[1] What I will try to demonstrate here is a relation between Freud and Winnicott, which is essential to understanding how the psychoanalyst works.
One of the overarching principles that makes psychoanalysis work, hard work, a struggle, or even, as Freud sometimes puts it, a battle, is present from his earliest writings. This is the principle that mind tends to divest itself of any disturbance. It can do so in two ways. One is to replace something disagreeable with something pleasant – this is wish fulfillment. The other is to eliminate the disturbance by attempting to render it nonexistent – this is defense. From 1895 on, Freud calls these two modes of getting rid of disturbance “primary process.” Primary process characterizes the larger, unconscious part of the mind, which ignores rationality. Consciousness is the possibility of ordinary reason, secondary process, which says that it is better to do something about a disturbance rather than wish or defend it away. But consciousness and reason are easily overwhelmed by wish fulfillment and defense, the processes that produce neurosis. To modify a neurosis is to shift the balance of forces in the mind, to diminish the dominance of primary process. The catch is that as a form of tension discharge, primary process expresses a basic tendency toward inertia. Psychoanalytic therapy, then, is always a struggle against the pull of inertia. No matter how much your symptoms make you suffer, you prefer the inertia they afford you. The analyst is always working against inertia – the proverbial uphill battle. I will recurrently return to the work against inertia.
Psychoanalysis has been historical from its inception. The content of any neurosis is an amalgam of elements from the individual’s entire life history. In his early period, Freud progressively extended what this history has to be. The beginning, the preanalytic hypnotic phase, was modest. Freud got his start from the purported discovery that the hysteric could recall under hypnosis the precipitating moments of her symptom, which she could not do in her normal waking state. Hence, “hysterics suffer from reminiscences,” that is neurosis is a question of memories not available to ordinary consciousness. At first these were recent memories of the onset of symptoms – onset always being a crucial medical question. As Freud proceeded, he came across the obstacle that not every patient could be hypnotized. Simultaneously, he found that symptoms were related not only to recent, not conscious memories of onset, but to chains of memories, extending deeper and deeper into the past, even back to early childhood.
While this idea is now part of our culture, it was a revelation at the time. But it also greatly increased the work of therapy, for both patient and analyst. Freud compares this work to a certain kind of archaeology:
Imagine that an explorer arrives in a little-known region where his interest is aroused by an expanse of ruins, with remains of walls, fragments of columns, and tablets with half-effaced and unreadable inscriptions. He may content himself with inspecting what lies exposed to view, with questioning the inhabitants – perhaps semi-barbaric people – who live in the vicinity, about what tradition tells them of the history and meaning of these archaeological remains, and with noting down what they tell him – and he may then proceed on his journey. But he may act differently. He may have brought picks, shovels and spades with him, and he may set the inhabitants to work with these implements. Together with them he may start upon the ruins, clear away the rubbish, and, beginning from the visible remains, uncover what is buried.[2]
In other words, a nonpsychoanalytic therapist will question a patient about his symptoms – the half-effaced tablets with unreadable inscriptions – but will do no more. The psychoanalytic therapist knows he has to dig to unearth the buried past, but cannot do so on his own. The patient, too, must dig. But here we have to recall the work against inertia. The past has been buried – repressed – because it is a disturbance. Analyst and patient must dig together, but at the crucial points the patient will have to refuse; the pull toward inertia will interfere. This is one way of characterizing resistance. The work has doubled: patient and analyst will have to work to overcome inertia so that the hard labor of excavation can continue.
One of Freud’s first discussions of the fundamental clinical phenomenon of transference – the patient’s inevitable playing out of the neurosis with the analyst – is put in terms of work for both patient and analyst. In the Studies on Hysteria, Freud demonstrates why the nature of neurosis has to produce transference in the treatment. The personal relation of analyst and patient cannot be avoided – not the usual way a doctor wants to proceed. Freud writes:
To begin with I was greatly annoyed at this increase in my psychological work, till I came to see that the whole process followed a law; and I then noticed, too, that transference of this kind brought about no great addition to what I had to do. For the patient the work remained the same: she had to overcome the distressing affect aroused by having been able to entertain such a wish [toward the analyst] even for a moment.[3]
In other words, the intensity of the personal relation between analyst and patient can annoyingly feel like even more work. But the scientific attitude toward neurosis understands the lawfulness of transference, which is as essential to the treatment as the overcoming of resistances. So this apparent increase in work is inevitable. The difficult work for the patient of overcoming a “distressing affect,” the struggle with resistance, is yet another version of fighting the pull toward inertia.
Throughout his life Freud said that what distinguishes analysis from all other therapies is the focus on transference and resistance. The crux of the treatment is in fact the intensification of the transference in the service of resistance. Freud speaks vividly of what happens when transference and resistance meet. The patient, he says, is “flung out of his relation to reality” – a kind of therapeutically induced madness. Freud’s clinical innovation was the recognition of the “lawfulness” of this process. While I have so far stressed the theoretical reasons for this lawfulness – primary process, wish fulfillment, defense, inertia – the actual experience should not be overlooked. The analyst must be able to weather intense emotional storms, and must be able to help the patient to do the same. So, while the analyst may not consider this to be additional work, a kind of forced overtime, it is still hard work. The difficult message of the analyst is that the treatment is not designed to help the patient leave a given session feeling better. No one really signs up for this. Can it be that as a patient I am being asked not only to dig exactly where I do not want to, but that I also have to endure all kinds of distressing feelings about the archaeologist who is asking me to dig? And pay for it?
There are two other forms of work Freud deals with specifically: working through and the work of mourning. To these I will add what I will call the work of life and the work of reality.
Freud introduces the method of “working through” in a technique paper from 1914. The paper is significant for introducing the idea of the repetition compulsion. To his conception of the basic principles of mind, Freud adds a compulsion to reproduce, often in action, the distressing psychic material being defended against. The repetition compulsion and resistance work hand in hand. “As long as the patient is in the treatment he cannot escape from this compulsion to repeat.”[4]
This intensifies the patient’s emotional work. One comes to treatment wanting to be relieved of suffering, but what is most repetitive about that suffering is actually the source of liberation from it. Freud writes that the patient’s “illness itself must no longer seem to him contemptible, but must become an enemy worthy of his mettle, a piece of his personality, which has solid ground for its existence and out of which things of value for his future life have to be derived.”[5] But what is of value in the symptom is inaccessible due to resistance, and the compulsion to repeat is also the stubborn repetition of the resistance itself. Clinically, resistance is never overcome simply by pointing it out to the patient. Rather:
One must allow the patient time to become more conversant with this resistance with which he has now become acquainted, to work through it, to overcome it, by continuing, in defiance of it, the analytic work (...) This working-through of the resistances may in practice turn out to be an arduous task for the subject of the analysis and a trial of patience for the analyst. Nevertheless it is a part of the work which effects the greatest changes in the patient (...).[6]
We have here yet another version of analyst and patient having to work in common just where working in common seems least possible. The patience demanded of the analyst is extreme, and the task of the patient “arduous.” Yet this is the deciding factor for bringing about therapeutic change.
In 1917 Freud wrote a paper on depression – melancholia – in which there is a famous comparison to mourning. Freud described the pain of mourning as a form of work:
In what, now, does the work which mourning performs consist? (...) Reality-testing has shown that the loved object no longer exists, and it proceeds to demand that all libido shall be withdrawn from its attachments to that object. This demand arouses understandable opposition – it is a matter of general observation that people never willingly abandon a libidinal position (...) Normally, respect for reality gains the day. Nevertheless its orders cannot be obeyed at once. They are carried out bit by bit, at great expense of time and cathectic energy (...) Each single one of the memories and expectations in which the libido is bound to the object is brought up and hyper-cathected, and detachment of the libido is accomplished in respect of it. (…) When the work of mourning is completed the ego becomes free and uninhibited again.[7]
In other words, we resist accepting loss. When loss imposes itself, we are preoccupied by it, and only come gradually to accept it by painfully withdrawing “libido,” mental energy, from all our attachments to who or what has been lost.
Many analysts have compared the process of analysis to this work of mourning. Let us once more think about inertia. Therapeutic change is a process of detachment from the inertia to which we are most attached. We do not at first know what this inertia is, why we are so attached to it, and how powerfully it dominates our lives. All of this has to be “worked through” in analysis, and all of it implies going over and over, repeating, the attachment itself and the resistance to its loss. And there is an inevitably depressing aspect to this work. In analysis one must not only come to see one’s symptoms as containing within them what is most valuable for one’s life. One must also face the depression of understanding how much of one’s life has been devoted to alienation from what is most valuable. There is no analysis in which therapeutic change does not produce intense sadness. Yet another form of difficult emotional work.
The work of life: In 1920 Freud rethought some of his basic presuppositions about the functioning of the mind. He introduced a death drive and a life drive. The death drive, as the most rigorous readers of Freud have noted, is actually a rethinking of the pull toward inertia. Freud’s idea is that the basic tendency to get rid of disturbances is equivalent to the reality that all life ends in death: the ultimate state of rest, the return of the living to the state of inert matter. Freud knowingly calls this idea “speculative.” But there is a crucial implication. The death drive, as the self-destructive force built into life itself, illuminates the difficult truth that individuals, groups, societies, and nations can prefer a self-destructive pull to inertia over life itself. What, then, is life? Freud sees a life drive as the basic antagonist of the death drive. Where the death drive radicalizes the pull toward inertia, the life drive moves in the opposite direction, “introducing fresh vital tensions into the organism”[8] as he says. In other words, here is a basic principle of mind, which challenges the exclusive dominance of the tendency to get rid of tension. Life itself is the productive integration of more tension. But because there is also a death drive, from the point of view of the pull toward inertia, life is also, as Freud says, a “mischief maker.” It will always be opposed by a self-destructive force.
Based on these conceptions, I would now recast everything outlined so far about the work of analysis. Its largest structure is the tension increasing work of life itself. Patient and analyst are not only excavating together, working through together, facing loss and depression together. The analyst’s work is also to bring the patient out of self-destructive inertia in favor of the increased tension of life. This cannot occur without a certain amount of pain, since increased tension is pain itself. This adds to Freud’s idea that one’s symptoms contain what is of most value for one’s life. What is of most value has been defended against, and produces resistance in analysis, because it is indissociable from the pain of life. The counterintuitive idea is that the work of analysis as the work of life is the work against the reflexive withdrawal from certain kinds of pain.
The work of reality: In the last period of his work, Freud was preoccupied with new ways of thinking about the mind’s relation to reality. He noticed something new, the strange phenomenon he called splitting of the ego. In this phenomenon, the ego, when faced with a disturbing reality, neither represses it nor denies it. Rather it simultaneously accepts and rejects it, thereby splitting itself into mutually incompatible states. The “side” of the ego that rejects the disturbing reality replaces it with a wish fulfilling fantasy. Here, we see the basic operation of primary process – wish fulfillment and defense working in tandem to get rid of a disturbance. But the new angle on this process is that the ego clearly would not undertake such a complex defensive manoeuvre if it did not in some way know exactly what it appears not to know.
What is surprising about this, is that at the very end of his life, Freud saw ego splitting as the foundation of all defensive process. Hence the title of his last, incomplete paper: The Splitting of the Ego in the Process of Defense.[9] There, Freud made a point that is both obvious, but also “puzzling,” to use his word. Given that any defense is an example of mind operating on itself, the fact of defense had always meant that what is being defended against is somehow known. Any defensive manoeuvre implies ego splitting. To work through the compulsion to repeat, especially the compulsion to repeat resistance, is then to work through ego splitting. Let us think again about the “work of life.” The hypothesis is that what the ego knows, but defends against, is on the “side” of increased tension, the pain of life. The “side” of the ego that rejects the disturbing reality is self-destructively using wish fulfillment and defense to maintain inertia, the reflexive withdrawal from certain kinds of pain. In other the ego attacks its own knowledge of precisely what it needs. Ego splitting is a kind of emotional autoimmune response that analysis works to reverse.
To understand this better I would like to quote a passage from an earlier work of Freud’s, Group Psychology and the Analysis of the Ego. In it, Freud is dealing with perhaps the most important social issue of all time, the apparently ineradicable hatred and destruction of others. He writes:
In the undisguised antipathies and aversions which people feel towards strangers with whom they have to do we may recognize the expression of self-love – of narcissism. This self-love (...) behaves as though the occurrence of any divergence from his own particular lines of development involved a criticism of them and a demand for their alteration. We do not know why such sensitiveness should have been directed to just these details of differentiation; but it is unmistakable that in this whole connection men give evidence of a readiness for hatred, an aggressiveness, the source of which is unknown, and to which one is tempted to ascribe an elementary character.[10]
In other words, what is other than I am is such a threat to my narcissism, my sense of intactness, that I am ready to hate and destroy that other. It is odd that Freud says the source of this elemental repudiation of difference is unknown. It fits in with his conception of the death drive, in its antagonism to the life drive with its push toward integrating “fresh vital differences.”
One can apply these ideas to ego splitting. The reality that the ego splits off can be part of the internal world or the external world. Let us focus on the internal world, which is the concern of analytic work. What one knows about oneself but cannot accept, what one defends against, can be conceived as what feels different about oneself, a difference that feels like a threat to one’s sense of narcissistic intactness. There is then the destructive autoimmune response to oneself. This expands the idea that analysis works to increase the “pain of life,” and is, I believe, the most encompassing way of conceiving therapeutic change.
By now I hope I have convinced you of the immensity of the work of analysis. What could such labor have to do with play? Actually everything, when one understands how this work gets done. Here is Freud using an analogy to play to describe the overall work of analysis:
Anyone who hopes to learn the noble game of chess from books will soon discover that only the openings and end-games admit of an exhaustive systematic presentation and that the infinite variety of moves which develop after the opening defy any such description (...) The rules which can be laid down for the practice of psycho-analytic treatment are subject to similar limitations (...) The extraordinary diversity of the psychical constellations concerned, the plasticity of all mental processes and the wealth of determining factors oppose any mechanization of the technique.[11]
In other words, like chess, analysis certainly has rules. But the rules of a game, especially a very complex game, cannot prescribe the actual play of the game. This is true of any game, and is also true for many medical procedures, as any honest surgeon will tell you. But it has a particular relevance for the psychoanalytic procedure.
How does an actual analytic session take place? Whether the patient lies on the couch or sits in the chair, the analyst always asks the patient to report whatever is coming into his/her mind without selection. This is called free association, which is a bit of a misnomer. Freud’s idea is that suspension of the usual rules of conversation, the suspension of purposeful speaking, giving oneself over to the play of whatever happens to come into one’s mind, is in fact quite rule bound. But the rules are unknown. They reside in the unconscious processes that determine one’s symptoms, defenses, transferences – of course, without one knowing it. In other words, the purpose of free association is to slowly reveal unconscious determinism. A necessary paradox exists here: the apparent goallessness of free association is the route to the treatment’s goal – therapeutic change. Returning to the questions of life and death, of reversal of the autoimmune response, I think it justified to say that the work of analysis is to introduce the tension raising play of life into the inertia of unconscious determinism, the unknown rules.
This overall conception of the analytic process has everything to do with play. Imagine a child playing – not a game with rules, but simply playing. What is one’s state of mind while playing? A kind of free attentiveness to oneself, to continuation of play via responsiveness to the process at hand. This state of mind is the one Freud recommends for the analyst. In listening to a patient, the analyst is not to exercise deliberate attention, because:
As soon as anyone deliberately concentrates his attention to a certain degree, he begins to select from the material before him (...) This, however, is precisely what must not be done. In making the selection, if he follows his expectations he is in danger of never finding anything but what he already knows (...) It will be seen that the rule of giving equal notice to everything is the necessary counterpart to the demand made on the patient that he should communicate everything that occurs to him without criticism or selection. If the doctor behaves otherwise, he is throwing away most of the advantage which results from the patient's obeying the ‘fundamental rule of psychoanalysis.’ The rule for the doctor may be expressed: ‘He should withhold all conscious influences from his capacity to attend (...)’ Or, to put it purely in terms of technique: ‘He should simply listen (...).’[12]
The Zen-like quality of Freud’s “rule” – simply listen – means that the analyst, like the playing child, is responding freely both to the patient, in the process at hand, and to himself. There is an important theoretical reason for this:
It is easy to see upon what aim the different rules I have brought forward converge. They are all intended to create for the doctor a counterpart to the ‘fundamental rule of psycho-analysis’ which is laid down for the patient. Just as the patient must relate everything that his self-observation can detect, and keep back all the logical and affective objections that seek to induce him to make a selection from among them, so the doctor must put himself in a position to make use of everything he is told for the purposes of interpretation and of recognizing the concealed unconscious material without substituting a censorship of his own for the selection that the patient has forgone (...) But if the doctor is to be in a position to use his unconscious in this way as an instrument in the analysis, he must himself fulfil one psychological condition to a high degree. He may not tolerate any resistances in himself which hold back from his consciousness what has been perceived by his unconscious; otherwise he would introduce into the analysis a new species of selection and distortion which would be far more detrimental than that resulting from concentration of conscious attention.[13]
When Winnicott said that if the analyst cannot play, he is not suitable for the work, I believe he was thinking of something like this. The analyst has to sustain a free responsiveness to the patient and himself. Why might an analyst not be able to do this? For precisely the reason Freud suggests: the analyst’s own defenses will inevitably interfere with his open responses to the patient’s process. The analyst’s responses would be determined by the unknown rules of his own wishes and defenses. This is why I would amend Winnicott to say that the work of analysis is to introduce play into those areas in which every patient cannot play, those areas in which wishes and defenses unconsciously govern a life. But to modify the governing rules of wishes and defenses, can feel like an unwelcome freedom. This is why Winnicott also says that play is “precarious,” and may lead to a “high degree of anxiety.”[14] Thus, he says, “games and their rules” are part of “an attempt to forestall the frightening aspect of playing.”[15] This frightening aspect of playing is the very work of analysis.
I will conclude with a small clinical example. It is an unusual example in that it shows the analyst making a somewhat dramatic intervention – not typical of the day-in, day-out work of analysis. But it does illustrate some of the above points.
A man in the middle of his analysis comes into a session and reports a dream. This man is used to the technique of free association, and dutifully begins to talk about various elements of the dream. In the dream there is a reference to the two main characters of a then-popular American television series – Hill Street Blues. These characters are a male chief of police and a female district attorney who, of course, have a complicated romance. As the patient talks, though, his associations seem to lead nowhere, and behind the couch my attention drifts. At first I am not even aware of this, and then I notice that I have actually missed something the patient has said. But recall the playing state of mind: ongoing responsiveness to the situation at hand, and Freud’s dictum that the analyst must be attentive to the play of his own mind. The usual view of work is that the analyst should be concentrating on what the patient is saying. The Freud/Winnicott view is that the analyst must be playfully open to his own experience.
So I think about this – clearly a directed form of work – and understand that it is more important to let my mind take me wherever it will than to concentrate purposefully. As I drift again, a vivid image flashes into my mind. I see myself in line at the supermarket the preceding weekend. The image seems to come from nowhere, and to have nothing to do with anything. Yet again, if I am to be responsive to the play of my mind I need to attend to it. So I do. I recall that it was a long line, that I was bored, and that I did what I always do when on such lines. I took the nearest magazine at hand to browse through. What was it? It was TV Guide: the then-ubiquitous listing of weekly television programs. And then I remember: on the cover of TV Guide was a picture of the two main characters of Hill Street Blues standing on top of a wedding cake.
And then I think about my patient, and everything I know about his own marriage, and its complex relation to his entire history and neurosis. I have a simple thought. I say to my patient that I am going to ask him an unexpected question. When is his wedding anniversary? He is amazed, and tells me that it is today, and that he has forgotten.
The point here is not to think of the analyst as a kind of magician. On the contrary, the point is the necessary relation of work and play in analysis. Had I not allowed myself to play mentally, even by losing my focus on the patient, I would not have let an unexpected image come into my mind, and then done the necessary work to see what it might have to do with my patient. And if one thinks about it, the example shows the operation of ego splitting, as the most general conception of defense. Clearly the patient both knew and then had not to know that it was his wedding anniversary. There was something painful about that knowledge that his dream was both expressing and hiding. Hence, both his memory of the dream, and the initial pointlessness of his associations to it. I could go over all the points above about the work of analysis, and show how the example relates to them. Of course I will not. Hopefully, though, I have given you some appreciation of the play at the heart of analytic work.