American Imago

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...