(Although the term was inherited by psychoanalysis from medicine, it has acquired a specific meaning in Lacanian psychoanalytic theory which is quite different from the way it is understood in medicine. )
Following the initial consultation, a series of face-to-face preliminary interviews take place.
After the preliminary interviews, the treatment is no longer conducted face to face, but with the analysand reclining on a couch while the analyst sits behind him, out of the analysand's field of vision (the couch is not used in the treatment of psychotic patients).
This is a dynamic process which involves a conflict between a force which drives the treatment on (see transference, desire of the analyst) and an opposing force which blocks the process (seee resistance).
The analyst's task is to direct this process (not to direct the patient), and to get the process going again when it gets stuck.
Psychoanalysis as a practice There is a parallel between dreams and symptoms. It was Freud's mature view that the symptom is the expression of a wish, a repressed wish. As with dreams, Freud went on to connect the repressed wish that the symptom expresses with sexuality. Every symptom is the expression of a sexual wish. The symptom expresses not only a repressed wish (or set of wishes) but also the forces of repression. This phenomenon is called compromise formation; the symptom must make concessions to the forces of repression, otherwise it too would be repressed. A symptom, then, is the expression and the satisfaction of a desire. We have to consider not only what the symptom achieves but also what it avoids. If it is a poor or substitute form of satisfaction for the impulse, it is vastly preferable to denying or renouncing the impulse altogether. For, if the impulse is denied, anxiety ensues. Sometimes we have internal conflicts which result in what we
The Freudian terrain 9 call neurosis. Neuroses may be obsessional (having to touch every lamp-post in the street), hysterical (developing a paralysed arm for no good organic reason), or phobic (being unreasonably afraid of open spaces or certain animals). Behind these neuroses, psychoanalysts discern unresolved conflicts whose roots run back to the individual's early development. The aim of psychoanalysis is to uncover the hidden causes of the neurosis in order to relieve the patient of his or her conflicts, so dissolving the distressing symptoms. Much more difficult to cope with, however, is the condition of psychosis, in which the ego, unable to repress the unconscious desire, actually comes under its sway. If this happens, the link between the ego and the external world is ruptured, and the unconscious begins to build up an alternative, delusional reality. The psychotic, in other words, has lost contact with reality at key points, as in paranoia and schizophrenia. 'Paranoia' refers to a more or less systematised state of delusion, under which Freud includes not only delusions of persecution but delusional jealousy and delusions of grandeur. Schizophrenia involves a detachment from reality and a turning in on the self, with an excessive but loosely systematised production of phantasies. 12 Psychoanalysis is not only a theory of the human mind, but a practice for curing those who are considered mentally ill or disturbed. An important aspect of the cure in Freudian theory are two processes called transference and counter-transference. Transference was for Freud the displacement of feelings from one idea to another; it is a mode of investing persons and objects with positive and negative qualities, according to our early memories of significant experience of familial figures. In the course of the treatment the patient, or analysand, may begin unconsciously to 'transfer' on to the analyst the psychic conflicts from which he or she suffers. This poses a problem ~for the analyst, since such repetition or ritual re-enactment of the original conflict is one of the patient's unconscious ways of avoiding having to come to/terms with it. We repeat, sometimes compulsively, what we cannot properly remember. The mechanism of transferring past experience on to the figure of the analyst is set in motion just when the repressed wish is in danger of emerging. 13 The nearer the analyst gets to the repressed complex which induced the illness the more the patient's 10 Jacques Lacan behaviour becomes pure repetition and divorced from present reality. S/he is in the grip of the 'repetition compulsion', the uncontrolled return of the repression. It is partly because of transference, and the insights and interventions which it permits the analyst, that the patient's problems are gradually redefined in terms of the analytic situation itself. Freud saw counter-transference as the analyst's uncontrolled response to the patient's transference. It has been defined as 'the whole of the analyst's unconscious reactions to the individual analysand - especially to the analyst's own transference'.14 Some analysts have suggested that there is transference and countertransference on the side of the analyst and the analysand. This concludes my exposition of Freud's chief ideas, but I will continually be referring to his theories and relating them to Lacan's work in the text. (I do not believe in the view that holds that one should study Freud first and Lacan much later.) I think Lacan should be studied, dialectically, with a constant reference to Freud.