Psychoanalysis or psychoanalytic psychotherapy? Shifting the debate from theoretical to clinical with the concept of analytic contact

Abstract

There have been numerous books, papers, panels, and debates over the years regarding the differences and similarities between psychoanalysis and psychoanalytic psychotherapy. This article shifts the often circular and political argument from a theoretical tug-of-war to a clinical focus. The author provides clinical material to show that frequency, diagnosis, or use of couch are at best external enhancements to a process of analytic exploration. The case material illustrates the concept of analytic contact, in which the aim of treatment, regardless of setting, is to establish an ongoing investigation into the patient's defenses, phantasies, and internal conflicts that come out of the patient's object relational experiences. Analytic contact is evoked, established, maintained, and protected by the consistent interpretation of transference and extra-transference experiences that occur in the treatment relationship. External issues and life circumstances cannot be avoided and must be given equal focus, but always in the pursuit of understanding their associated underlying object relational phantasies. Clinical matters must take precedence over theoretical ideals in the struggle to establish analytic contact. The analyst consistently seeks, sometimes failing and sometimes succeeding, to understand how the patient either builds on genuine analytic contact or seeks to dismantle it.