Reviewed by:

• A Fresh Look at Psychoanalytic Technique, Selected Papers on Psychoanalysis by Fred Busch
• Timothy Sawyier¹ (bio)

At a book talk at the University of Chicago’s Seminary Co-op Bookstore a few years ago, an eager student asked Professor Jonathan Lear, “Why does psychoanalysis take so long?” Lear replied, “Well, if I just tell you what’s wrong with you, it’s only going to make you mad, especially if I’m right.” Lear’s response was an efficient and very amusing introduction to the clinical quandary of resistance, to which Fred Busch’s latest book, A Fresh Look at Psychoanalytic Technique, also addresses itself. Aptly appearing on the eve of the centenary of The Ego and the Id (1923), A Fresh Look elaborates what Busch sees as the unmined clinical implications of Freud’s structural model and 1926 revision of the theory of anxiety,² in particular striving to integrate the concept of unconscious resistances into a coherent theory of clinical technique. In papers spanning the past 30 years, newly collected here, Busch’s book offers an erudite examination of the clinical ramifications of the shifts in Freud’s theorizing during the 1920s, while it also evinces some limitations of adhering to a century-old model of the mind.

Busch seeks to address the “developmental lag” between theory and technique identified by Paul Gray (1982): the widespread persistence of a clinical stance based on Freud’s topographic model and committed to uncovering unconscious content, despite the greater clarity Freud provided with the structural model and second theory of anxiety. In Freud’s topo-graphic model, forbidden wishes are censoriously repressed, yet continually striving for expression, resulting in a damming up of libidinal impulses that ultimately gives rise to psychic pressure and symptoms. According to this picture, the therapeutic task is to bring repressed wishes into the light of consciousness so [End Page 783] they will cease agitating from the depths. Clinical experience soon led Freud to realize, however, that announcing to patients what lurked repressed in their unconscious did little to alleviate their neurotic suffering. Indeed, he found patients often had quite a reaction to the analyst’s announcement of their buried, inconvenient truths, and that these reactions “resisted” or “defended” against what light the analyst was attempting to shed. As Freud’s investigations progressed, he further appreciated that such defensive measures themselves had to be unconscious, but not dynamically repressed in the manner of forbidden wishes. These developments—the mechanisms of resistance, and of their unconscious-yet-not-repressed status—were decisive in the ultimate formulation of the structural model, particularly the recognition of an unconscious portion of the ego.

Enter Busch, who correctly observes with Gray (1982) that the implications of these developments in Freudian thought were slow to enter the larger clinical consciousness. Particularly in three essays from the early 1990s, reprinted as chapters in A Fresh Look—“Thoughts on Unconscious Resistances” (1992), “In the Neighborhood” (1993), and “Some Ambiguities in the Method of Free Association and their Implications for Technique” (1994)—Busch lays out how psychoanalytic technique remained committed to the interpretation of unconscious content to the patient, while failing to address what about such content was threatening to the ego (i.e., why it was repressed in the first place). Telling someone what they are resisting of course does little to address the resistance itself—indeed often exacerbates it—and to confront resistances with exhortation fails to understand how they actually operate.

These early papers in A Fresh Look amount to a convincing plea for a shift from an interpretative stance that informs the passive patient of what is being warded off in their mind, to one that actively engages them in the process of understanding how and why they keep certain thoughts and feelings at a distance, enormously valuable guidance for beginning and seasoned clinicians alike. For Busch, such a posture is what ultimately brings about what he sees as the desired outcome of an analysis: changing “the inevitability of action into the possibility of reflection” (or as the title of a previous book [End Page 784...

审核人：

• 重新审视精神分析技术， Fred Busch精神分析论文选集
• 蒂莫西·索耶¹（生物）

几年前，在芝加哥大学神学院合作书店的一次读书会上，一位热心的学生问乔纳森·李尔教授：“为什么精神分析需要这么长时间？” 李尔回答说：“好吧，如果我只是告诉你你有什么问题，那只会让你生气，尤其是如果我是对的。” 李尔的回应是对抵抗的临床困境的有效且非常有趣的介绍，弗雷德布施的最新著作《精神分析技术的新视角》也谈到了这一点。恰如其分地出现在《自我与本我》 (1923 年)一百周年前夕， 《新鲜的面貌》阐述了布希认为弗洛伊德的结构模型和 1926 年对焦虑理论的修订的未经挖掘的临床意义，²特别是努力将无意识抵抗的概念整合到连贯的临床技术理论中。在这里新收集的过去 30 年的论文中，Busch 的书对 1920 年代弗洛伊德理论转变的临床后果进行了博学的检验，同时它也表明了坚持一个百年历史的思维模型的一些局限性。

Busch 试图解决由 Paul Gray (1982) 确定的理论和技术之间的“发展滞后”：尽管弗洛伊德提供的结构模型更加清晰，但基于弗洛伊德地形模型并致力于揭示无意识内容的临床立场广泛存在和第二种焦虑理论。在弗洛伊德的地形图模型中，被禁止的愿望受到严密压抑，但仍不断努力表达，导致力比多冲动受阻，最终导致心理压力和症状。根据这张图片，治疗任务是将被压抑的愿望带入意识之光，因此[End Page 783]他们将停止从深处搅动。然而，临床经验很快使弗洛伊德意识到，向患者宣布潜伏在他们潜意识中被压抑的东西并不能减轻他们的神经症痛苦。的确，他发现病人常常对分析师宣布他们隐藏的、不便的真相有相当大的反应，并且这些反应“抵制”或“捍卫”分析师试图揭示的真相。随着弗洛伊德调查的进展，他进一步意识到这种防御措施本身必须是无意识的，但不会以被禁止的愿望的方式被动态压抑。这些发展——抵抗机制及其无意识但未被压抑的状态——对结构模型的最终形成具有决定性作用，

Busch 进入，他与 Gray (1982) 一起正确地观察到，弗洛伊德思想中的这些发展的含义很难进入更大的临床意识。尤其是 1990 年代初期的三篇文章，作为《新面貌》中的章节重印——“关于无意识抵抗的思考”（1992 年）、“在邻里”（1993 年）和“自由联想方法中的一些歧义及其对技术”（1994 年）——Busch 阐述了精神分析技术如何始终致力于对无意识内容的解释患者虽然未能解决这些内容对自我构成威胁的问题（即，为什么它首先被压抑）。告诉某人他们在抵制什么当然对解决抵制本身没什么帮助——实际上往往会加剧它——并且用劝告来对抗抵制并不能理解它们的实际运作方式。

A Fresh Look中的这些早期论文提出了一种令人信服的呼吁，即从一种解释性立场转变为一种转变，这种解释性立场告知被动的患者他们的想法中正在避开什么，积极地让他们参与到理解他们如何以及为什么保持的过程中。远距离的某些想法和感受，对于新手和经验丰富的临床医生来说都是非常有价值的指导。对于 Busch 来说，这样的姿态最终会带来他所认为的分析的预期结果：将“行动的必然性转变为反思的可能性”（或如前一本书的标题[End Page 784 ...