Abstract
This collection of Ralph Greenson’s training seminars, based on verbatim transcripts of audiotaped sessions from 1959 and 1975, brings a current generation of readers into the classroom with one of the most distinctive voices in midcentury psychoanalysis. The Technique and Practice of Psychoanalysis: Volume 1 (1967), Greenson’s influential and popular book, has been followed by a series of posthumous publications from the Ralph R. Greenson Archive of the San Diego Psychoanalytic Society and Institute. The Technique and Practice of Psychoanalysis: Volume 3 (Greenson 1994) is the first book in a planned eight-volume series based on Greenson’s training seminars and lecture notes. Each book in the series is organized according to a topic outline developed by Greenson himself. This volume focuses on the analytic treatment situation, analyzability, suitability for psychoanalysis, and resistance. In the editor’s introduction, Harry Polkinhorn includes a brief biography of Greenson, a history of the publications resulting from the materials left after Greenson’s death, a summary of plans for future publications, and a discussion of the editing challenges regarding this material. The transcribed audiotapes constitute the entirety of this book except for brief references at the end of each chapter.
Greenson is a masterful teacher with a strong command of the psychoanalytic literature, but he is most interested in the practical application and clinical usefulness of the ideas he discusses. He teaches with vigor, humor, and candor. The best part of this book is getting to know Greenson. Reading it feels like entering a psychoanalytic time capsule, invisibly sitting in a classroom of a different era. Greenson allows the reader to know him, to see how his mind works, to understand how deeply he feels for his patients and students, and to witness firsthand his warmth and respect in talking with them. He comes across as unafraid of challenging conventional wisdom, expressing strong opinions, or asking basic questions. For example, in the first chapter, on the analytic situation, he asks: “What forces within the patient are on the side of the therapist?” (p. 16). “What’s against you, fighting the analysis every inch of the way?” (p. 17). “What do you try to get the patient to do in analysis?” (p. 23). Greenson is firmly entrenched in a classical model but encourages his students to think independently and always with an eye toward making the psychoanalytic encounter humane and understandable to both patient and analyst. He touches on a variety of ideas in discussing these beginning questions, mentioning Freud, Jacobson, Hartmann, Rapaport, Glover, Fenichel, Calef, Strachey, and Lewis Carroll in the first chapter. Greenson defines the psychoanalytic goal from the outset: “Our main aim or our main task or where we do most of our work is not to strengthen the ego. . . . Our main aim is to constantly attack the defenses as being inappropriate, useless, a high price to pay . . . by first of all interpreting to the patient and demonstrating to the patient the preconscious derivatives of the conflicts and how they operate” (p. 23).
Greenson’s ability to maintain a practical clinical focus is one of the strengths of the book; however, his tendency to veer off on tangents occasionally lends a sense of disorganization and incompleteness to the topic under discussion. The reference lists at the end of each chapter include brief but helpful notes to orient the reader to the people Greenson discusses and their place in psychoanalytic history. The book would be improved by expanding these for readers not familiar with the literature and by including short summaries at the start of each chapter or marginal notes on the main themes and ideas and their relevance for clinicians today. In the excitement and give-and-take of each seminar, it is easy to lose focus on the topic under discussion. The accuracy of the transcription, however, allows the reader to see Greenson as “profoundly human, the kind of person who cracks jokes, blows cigarette smoke all over the room, and dabs a tear of fellow feeling from the corner of his eye” (p. 12). The tangents he veers off on become part of the charm and appeal of this book, and I was grateful in the end for allowing these to be included in their entirety. The discussions here are not comprehensive or authoritative treatments of the chapter topics but rather lively debates in which Greenson uses clinical material to ground his opinions and recommendations. He ranges widely in his comments in each seminar and allows the cases, the questions from his students, and the stories from his life and practice, rather than the topics, to guide the discussion.
The book evokes a desire to answer back and participate in the seminars, and there is a palpable sense of being carried along in the excitement of the discussion. Greenson has the ability to get to the heart of complex ideas and to think critically about the concepts he addresses. He unabashedly shares his personal reactions and encourages his students to do the same, never appearing intimidated by the authority of the analysts whose ideas he considers, including, in some cases, his own analysts, Stekel and Fenichel. An unexpected benefit this book confers is that it reintroduces the reader to psychoanalysts whose work is not read as frequently today as in past decades. While openly debating the value of many seminal contributors (e.g., Klein, Hartmann, Rapaport, Fenichel, Glover, Stone), Greenson explains clearly what makes sense to him and how he works. For example, he discusses Fenichel’s description of a patient (1941) who likens free association to the movement of a needle on a compass: Fenichel thought that it was a very good description, because sometimes there was either too much movement of this needle, and then he didn’t know where it was, or then the needle got stuck somewhere. . . . I just wonder what it seems like to you. Think about it. I’ll tell you what it seems like to me. When I listen to the patient I’m very much aware of a central feeling that I have about it. . . . The patient is going toward something, or going away from something. I’m constantly listening with this. I’m aware of a going to or a going away. Fenichel described it with the needles. . . . I don’t see it as a needle, but I am always listening and can hear, no matter what else is happening, the going toward something or going away from something. . . . To me it seems that certain notes are being played by the patient, musical notes . . . how they combine, but the patient is playing lots of notes, and that if I listen long enough, I’m going to hear there is a melody somewhere that I couldn’t recognize before, or I would say it another way. The patient is making brush strokes on a canvas. Of course, the canvas has a background already, and if I watch long enough and well enough, and if the patient is not avoiding it, I’m going to see a picture emerge from the brush strokes [p.106].
Many of Greenson’s musings have a poetic quality while also being rooted in what he considers clinically useful. His interest in theory and technique is fueled by the desire to advance his skill as an analyst, and he delights in prompting his students to consider innumerable practical questions. These include controversial and seldom discussed topics that Greenson answers with memorable and often humorous one-liners. He inquires whether “a stupid person” is analyzable (“It’s harder on the analyst, but if a man is smart enough to have a neurosis, he should be smart enough to be cured” (p. 54); what it’s like to analyze wealthy patients (“Many times I’ve had to say to them, ‘I’m not your servant,’ because it comes up again and again, in dreams, in particular” (p. 62); whether to suggest use of the couch (“You can’t put a person on the couch unless you have thoroughly analyzed, or partially analyzed, his fear of the couch” (p. 68); and whether to talk to a colleague who conducted an unsuccessful treatment with a patient he himself has later successfully analyzed (“Yeah, what the hell. Aren’t we all our brother’s supervisors?” (p. 40). Greenson is not afraid to stake out unpopular positions as long as they make sense to him. For example, contrary to the prevailing view at the time that analysts were interchangeable, Greenson asserts the importance of a thoughtful fit between patient and analyst: “There must be some similarities between me and my patient, and we must be different. If I am too much like my patient, I will not work well with them. But if we are too different, I will not have the capacity for empathizing with that kind of a person. . . . There must be some matching. It’s almost like finding a marriage partner. . . . it has to do with balance between, the optimal balance between similarities and differences” (p. 43). Throughout the book are instances where Greenson questions or disagrees with received wisdom and reveals how prescient he is regarding changes to come in psychoanalytic technique and practice.
The chapters on preparing the patient for analysis and beginning treatment are excellent and highly relevant today. Greenson tells the reader explicitly how he explains free association and use of the couch, why he dislikes the term “trial analysis,” why he hedges about answering questions about the length of analysis, and how he sets a fee and deals with missed hours. This is one of the most clinically helpful sections in the book and would be extremely valuable to beginning candidates and to teachers looking for practical and thought-provoking readings on these topics.
Over half the book is devoted to discussing resistance. While some of the material presented here is dated, it is never confusing. Greenson is firmly rooted in an ego psychological model and views analyzing resistance as “the daily bread of psychoanalytic work” (p. 125). He begins this discussion with an invitation to his students to consider some basic questions: “Is resistance an artifact? Is resistance brought about by analysis? . . . Is it impossible to have an analysis without resistance? . . . What is the relationship between resistance and defense? . . . What is a symptom?” (pp. 108–109). Using simple language and a gentle Socratic method, Greenson coaxes his students to answer these questions and continually challenges them to focus on why these ideas matter, their centrality in understanding patients. He emphatically conveys his belief that identifying and working with resistance defines a treatment as psychoanalytic and is essential to being able to practice as an analyst. He emphasizes that patients’ ability to identify and wrestle with their resistance means that they are truly “in analysis” (p. 130).
Greenson highlights many basic principles of technique in this section that today may not be transmitted as clearly or assuredly to candidates. For example: “Resistance analysis leads to content analysis . . . you can’t analyze the content unless there’s a reasonable ego, and as long as there’s strong resistance, you don’t have a reasonable ego” (p. 144); “There are certain interventions that you must make sometimes in order to increase the resistance so that it is demonstrable to the patient. . . . it’s got to be demonstrable to the patient, not to you” (pp. 126–127); and, finally, “In general, when an interpretation is followed by intellectualization and a great deal of verbalization, and a kind of ingratiating scrambling for confirmatory evidence, when this kind of thing happens, by and large the patient likes the interpretation, and if they like it there’s something wrong with it” (p. 150). In this section Greenson stresses that the analyst’s main tasks are to detect and monitor resistance and to assess the patient’s reactions to interpretations. It is likely that some of his ideas may come across as limited or dated to current generations of analysts accustomed to thinking about topics like intersubjectivity, nonverbal communication, self-disclosure, and enactment. What is striking, however, in looking carefully at many of the cases Greenson shares, is that, although he does not have the language available to us now, he intuitively understands and touches on many of these concepts. For example, he talks about his observations of nonverbal behavior and how to work with this analytically and thinks about how patients put things into action in the analytic session that reveals important information about what is happening—or not happening—in the analytic work itself. Greenson’s deep empathy for his students and patients shines through and shows, rather than tells, what it is like to be engaged in a psychoanalytic enterprise. The continued focus on resistance throughout the book may serve as a sort of antidote to a sense of diffusion regarding the role of the analyst today and underscores how valuable and useful are the fundamental principles Greenson espouses. As in psychoanalysis itself, in joining with Greenson to focus on resistance, there is a sense of rediscovering essential truths that may have faded from recent memory.
Greenson uses language evocatively and talks to his students about paying close attention to how others use language. He stresses, in the last section of the book, how language often serves resistance and how analysts may collude by not asking for more detail about patients’ vague statements. He emphasizes that this is especially notable regarding sexual material: This is one of the most important sources of resistance that escape unnoticed by analysts. Time and time again I listen to control hours, and the patient has said, “Well, and we made love and it was very satisfying.” That’s all, and the candidate lets it go by, and off they go. . . . I feel these are partial statements, which really hide important component impulses and component drives and feelings, which are permitted to remain obscured by the analyst’s tacit acceptance. . . . I was amazed when colleagues of mine said, “My, you go into a great deal about sexual activities!” What do you mean, I go into great detail? What greater area is there of getting insight into all of object relations than in the sexual relations, and actually the sexual actions and the sexual sensations? Here I get the closest to the id, and the closest to object relations I will ever get [pp. 171–172].
In helping patients recognize and work with their resistance, Greenson acknowledges that “it’s necessary to have the tact to ask enough so you uncover, but not that you are a cold-blooded hunter after the facts. No, you must have a little bit of feeling for the person” (p. 173). He urges his students to use “childhood language” in order to make an interpretation emotionally alive and to connect it with early experience: “I never say to a patient, “You’re afraid,” or “You’re apprehensive.” . . . If you’re apprehensive you’re a training analyst. You’re not a patient. “You’re scared,” yes, scared, and how much more vivid that is than to be afraid . . .” (pp. 134–135). Greenson animatedly speaks with his students about how to talk to patients to evoke feeling, to pay attention to both what is said and what is unsaid, and to work with behavior patients engage in on the couch. He explores the meaning of secrets, how to understand patients who cannot say certain words, and what behavior like sighing or yawning means. Greenson thinks about language from a resistance framework, demonstrating his careful attention to the meaning of phrases his students might consider innocuous: A pet theme of mine is to collect what I call the language of resistance, things patients say in everyday talk which are resistance, small, but are resistance. For example, the patient says, “Really and truly, I’m really and truly sorry that I came late,” . . . they mean, you know, “I’m aware of an opposite feeling,” . . . which is, “I’m not sorry I’m late, I’m glad I’m late. To hell with you,” . . . when a person does really mean it and is truly sorry, he says, “I’m sorry.” When they start to say, “I’m really,” they cover up some kind of an ambivalence. . . . “I don’t know where to begin” means, “I know where to begin but I don’t want to.” . . . Another is the patient saying, “You know, my uncle so and so. . . . You remember my cousin John.” When they start saying, “You remember . . . “ it means, “I know, you dope, you don’t remember, but I’m being tactful.” It always means this. “I hate to tell you, you have a terrible memory. You’re getting senile all right.” . . . They always add, “you know,” and “you remember,” which means, “I doubt your mental capacities, but I’m too much of a gentleman to say it” [pp. 176–177].
Greenson sprinkles his teaching with personal anecdotes, his opinions about other analysts, and verbatim accounts of interactions with his patients. A sense of continuity and an appreciation of the enormous contributions Greenson made to the field imperceptibly builds in the reader, along with a sense of connection with a number of figures throughout psychoanalytic history. Joining Greenson in these seminars feels like entering and inhabiting a living history. There are many gems of insight, but perhaps what comes across best is Greenson’s ability to model and instill in his students and in the reader his passion for psychoanalysis. His straightforwardness and ability to speak and write with simplicity and clarity about topics of depth make him one of the great teachers of psychoanalysis. It is a gift to current generations of students to be able to learn from him today.