Process‐orientated psychoanalytic work in initial interviews and the importance of the opening scene

Abstract

From the very first moment of the initial interview to the end of a long course of psychoanalysis, the unconscious exchange between analysand and analyst, and the analysis of the relationship between transference and countertransference, are at the heart of psychoanalytic work. Drawing on initial interviews with a psychosomatically and depressively ill student, a psychoanalytic understanding of initial encounters is worked out. The opening scene of the first interview already condenses the central psychopathology - a clinging to the primary object because it was never securely experienced as present by the patient. The author outlines the development of some psychoanalytic theories concerning the initial interview and demonstrates their specific importance as background knowledge for the clinical situation in the following domains: the 'diagnostic position', the 'therapeutic position', the 'opening scene', the 'countertransference' and the 'analyst's free-floating introspectiveness'. More recent investigations refer to 'process qualities' of the analytic relationship, such as 'synchronization' and 'self-efficacy'. The latter seeks to describe after how much time between the interview sessions constructive or destructive inner processes gain ground in the patient and what significance this may have for the decision about the treatment that follows. All these factors combined can lead to establishing a differential process-orientated indication that also takes account of the fact that being confronted with the fear of unconscious processes of exchange is specific to the psychoanalytic profession.

“Meaningless carrying-on”: A psychoanalytically-oriented qualitative study of compulsive hoarding.

“…Using a psychoanalytic method and analysis allowed for consideration of the “entirety of the interactions” (Wegner, 2014), and in doing so, accessed additional sources of information beyond the manifest layer of the words exchanged. This method proved to be a good fit for the topic of research chosen, as hoarding and belongings were rarely directly addressed.…”

Finding Control Cases and Maintaining Immersion

“…Several analysts have suggested that initial encounters are disturbing in ways that we do not consciously perceive but that both participants, unconsciously or preconsciously, register and react to (Ogden 1992;Rothstein 1995;Ehrlich 2004Ehrlich , 2010Ehrlich , 2013Levine 2010). Findings from qualitative research by the Working Party on Initiating Analysis (clinical workshops studying initial interviews) provide further support for this view: (1) regardless of how tranquil it might appear, the initial encounter between the patient's and the analyst's intense fears and wishes precipitates an emotional storm (Reith 2010(Reith , 2012Reith et al 2012) ; (2) for analysis to begin, the analyst must bear the initial transference/countertransference and transform it into a beginning appreciation of the patient's suffering and its meaning (Reith 2012;Vermote 2012) ; (3) which patient is analyzable is determined not by objective criteria but by whom the analyst thinks it possible to work with (Møller 2014;Wegner 2014). Observing that analysts in the workshops often disagreed as to which patient should be offered analysis, Møller (2014) concludes that "it is something in the individual analyst's way of reacting to the patient that determines the outcome, and not some constant called analyzability" (p. 494).…”