Vasilios Maoutsos
What I often see in the psychoanalytic literature and in many clinical presentations in relation to the topic of discussion here, is that the free associations of patients are interpreted more or less as if they were a state separate from the dreams they bring for analysis. On the one hand, there are their free associations and on the other hand, there are their dreams as two independent states where the analyst often conveys a climate of uniqueness and excitement about the existence of a dream and its interpretation! In this sense, it seems as if they are two different states even if they take place in the same analytic space and concern the unconscious processes of the same patient.
I would therefore like – given the opportunity of this Symposium – to take a position on this, in my opinion (and the opinion of many colleagues who embrace the classical Freudian positions) extremely important issue, developing my views, which happen to stem directly from Freud ‘s written texts on this subject, specifically ‘The Interpretation of Dreams ‘ of 1900 and works such as ‘ Dream Analysis of Ella Freeman Sharpe of 1978 and many others.
Specifically, I intend to suggest that one is a continuation of the other: that free associations have within them the dream element as well as the opposite. At the same time, I would like to bring some clinical material that will help me to describe more clearly the practices, that is, the clinical parameters, of an issue that in my opinion remains even today theoretically acceptable but clinically inapplicable.
Let me begin, then, with the description of the dream of a patient of mine whom I have been seeing five times a week for almost four years, after a three-year break, when, after a year of treatment with me, he feared that the material from the analysis of his dreams that he had just begun would upset him and make him waste – as he put it – his precious time on ‘nonsense’. However, when he had gone to continue his analysis with a colleague, he discovered that the depression from which he was suffering had transformed over the course of three years into very intense psychosomatic problems, specifically into severe precordial pains, sexual impotence, increased blood pressure and fainting tendencies. During these three years, he had no dreams and, panicked by the exacerbation of his psychosomatic disorders, he interrupted this second analytic attempt and returned to his first analyst. During this time he had considered that the ‘secret’ to his problems must be hidden in his dreams which he always remembered with surprise that for me they constituted a very important part of his analysis. So, he thought, that perhaps I could bring ‘these dreams’ back to him and he would finally recover from a situation that threatened his professional, sexual and social existence even if he himself still did not understand what on earth one could expect from dreams. At the same time, however, since they were so important to me, he had no doubt that he should in no way underestimate them. In any case In any case , he was sure from the beginning that he himself could never imagine himself analyzing his dreams! This was something I would do for him. So my patient came back to me with a ready transfer of trust in my ability to see into the depths of his unconscious, at the same time with a fear of facing what he would see in and around his dreams but also with an egotistical curiosity to learn from me how to explain what was happening to him in relation to his dreams.
As you can see, it was quite clear from the beginning that my patient was not referring to his real dreams: he had returned to me to see together an internal ‘enemy’ lurking and attacking him, an enemy whom we wanted to kill together, to exterminate together so that he would not dare to approach him again or, if he did approach him again, to have him in his hands. This ‘enemy’ for my particular patient meant ‘ dream ‘, this mental state had been symbolized within him as a ‘dream’. And his associations in these first sessions were clearly of a real character but to a significant extent of an unreal, that is, dreamy character : it was the dream element deeply in the transference and showed that he wanted to be subjugated after his return to me. He was indirectly apologizing to me for leaving and wanted me to take him by the hand now and go kill the dream monster together. Isn’t this, in itself, a perfect dream that needs interpretation even if it is also a typical transference situation?
So when my patient began his analysis, he had the following, this time real, dream: he was with his girlfriend and his good friend in a tourist resort when suddenly a policeman appeared and was wandering outside the hotel complex where they were staying with the obvious intention of arresting him for some initially unknown reason. He thought, however, that his arrest would probably have to do with some financial irregularities of a tax nature and with contributions of the order of 5×200, without knowing what these numbers meant . In the continuation of the dream, he was with a man – perhaps his good friend, perhaps someone else – in the double bed of the same hotel or, an apartment, which, however, had the characteristic that the balcony of the room was a continuation of the street that passed outside it. So, lying in bed, he enjoyed the view of the street and had the impression that he owed me 400E, which when he recalculated it was only 375E.
immediate associations in this dream were as usual of the type: ‘Honestly, I can’t understand anything from this dream. How you can and do draw the conclusions you draw from my dreams is a mystery. But what impresses me is the fact that now I am sure that the interpretations you give are correct. I just can’t think of them.’ This call , in a way, to go inside himself and catch the supposed ‘enemy’, was basically his immediate association in every dream. He could say nothing else about his dreams. But his indirect associations, that is, his free associations, what he said without apparently being related to his dreams, are more important for my present presentation, because they show that both – free associations and the dream – although apparently separate situations are in essence nothing more than gradations and defensive differentiations of the same unconscious needs, each of which is consequently expressed in a different way.
In this sense, I could immediately give a definition of what a dream is and include in it the definition of what free association is. And these two definitions will be given through a metapsychological prism – combining the totality of mental functions – because only in this way will the existence of a substantial relationship between the two be able to make sense.
Indeed, the dream, from a metapsychological point of view, is nothing more than an extreme form of free association and therefore always exists within it, just as free association is an intermediate expression of a dream and therefore always exists within it: the psychic economy, the relationship between the conscious and the unconscious, as well as the defensive tactics, are redefined – even if this is temporary – after each dream, just as these same parameters try, but with less success, to be redefined through each free association.
However, on an empirical level the fact that this is true does not appear. Hence, whenever we talk about a dream, we always consider that our consciousness has fallen to such an extent that we do not know our relationship with reality. That is, indirectly but clearly, in the case of a dream we unconditionally accept the existence of the unconscious and the waiver of all responsibility for the hidden content of the dream as if it were something cut off from reality. In the case of free association, the exact opposite happens on an empirical level: we exclude the existence of the dream element as if reality were sought in it at all costs.
There is a clear necessity for separating these two psychic expressions, although we know how inadequate such an approach is. In psychoanalytic practice, we know beyond a doubt that the simple transference interpretation of free associations could in no way ever be characterized as the last word on the path to the unconscious. Freud considered the dream to be ‘the royal road to the unconscious’ not only because the existence of the dream, in itself, makes free association, de facto, an expression of limited scope, but also because the discovery and interpretation of the dream element in each free association leads us from the safe to the deeper unconscious and is just as important as the dream itself.
The question therefore arises as to why there is such a clear contrast between dream and free association. I suppose that this clear distinction between them expresses the dual nature of the function of the unconscious and therefore from a clinical psychoanalytic point of view it constitutes a matter of major interest. If we want to examine what are the main differences that exist between dream and free association, I think we will easily come to the conclusion that it is a matter of a qualitative difference in some of the defenses used : in the case of the dream there are defenses that appear as extra-subjective character, while in the case of free association the defenses are intrasubjective character . The former, let’s say, are reported by the patient as if they were something outside of him, in the form of projections, while the latter are described as something that directly concerns him, in the form of intrapsychic conflicts.
Thus, in the case of the dream the defenses have a primitive character in the sense that they separate the state of consciousness from the state of non-consciousness. The dream is a dissociative or, schismatic state or, schistic state . This does not contrast with free association where any defense processes have a unifying character of mental functions.
Through this basic assessment of the defensive process in the dream we arrive at corresponding clinical assessments. Here, then, is the reason why we can easily define, as Freud originally defined it, the dream as a state of psychosis: this was always done based on the criterion of the separation caused in consciousness between external and internal reality. And, here, also, is the reason why we consider free association a neurotic process based on the fact that there is no dividing line but on the contrary there is a tendency for the functions of the psyche to be united, whether they refer to the external or to the internal space of the subject.
But what is the reason why there is such a great differentiation of defenses between neurotic – intrasubjective and psychotic – extrasubjective and what is their generative characteristic? The answer to this question has to do with the concept of what role the environment plays in the human condition and why, in all case , to experience his existence as so problematic.
Freud negotiated this issue through the concept of narcissism. Basically, what he proposed and has never been seriously questioned to this day, is that the ‘environment’ – what in psychoanalysis is sometimes referred to as the ‘ object ‘ and sometimes as the ‘other’ – the environment, then, is a situation that is basically unacceptable on an unconscious level or, the individual can hardly tolerate it , especially in the very early stages of life. In contrast to the environment, the ‘self’ which is created and gradually evolves constitutes an experience which is much more consistent with the concept of pleasure and individual satisfaction and is therefore much preferable to the environment. There is, that is, the paradox , as commonly called, where the deepest human satisfaction is the direct product of the sense of self, and dissatisfaction and discomfort are the direct result of the concept of the environment or, the object. In this sense, the imposition of the ‘other’ or, the ‘environment’ on the ‘self’ constitutes the major failure of the latter on the former and given that it is something inevitable de facto, it becomes the most decisive point in human evolution.
The significance of this imposition lies in the fact that the environment or the other or the object – whatever we call the external factor – breaks the barrier of narcissism , that is, they break the barrier of the pleasure that the individual derives from himself and consequently the individual’s ‘self’ is experienced gradually and more and more throughout life as the object of the environment’s appetites. The state in which the self accepts the other, the state, that is, of the socialization of man, constitutes a pleasant predisposition resulting from an initially unpleasant experience of his . The decisive point of this process is the Oedipus Complex. It is precisely this path to the Oedipus Complex that Freud described as primary masochism , and its resolution constitutes the elucidation of the deepest relationship of man with himself, and on the basis of this relationship his entire subsequent course depends. For the beginning of masochism leads to sadomasochism and satisfaction from it, as well as to a multitude of clinical conditions, since the repetitive predisposition perpetuates it indefinitely .
In the case of the dream, then, we understand that the regression to the narcissistic psychosis of the dream state is nothing more than a re-experiencing of the satisfaction of the basic relationship of the instincts with themselves , with their ‘nature’, whatever that may be. That is to say, what happens in the dream and to some extent constantly tends to happen in the free associations of the psychoanalytic process is the return of man to the state of absolute individual pleasure which is fundamentally opposed to any concept of evolution and progress as it is widely understood.
The distinction therefore between the death instinct and the life instinct or erotic instinct should always be made by taking seriously into account the dimension of satisfaction or, more precisely, the primary, narcissistic satisfaction, which is deeply hidden within the death instinct, in contrast to the masochistic satisfaction which is intertwined with the life instinct or, the erotic instinct and which is only superficially attached to it. Only in this sense, that is, of the opposition between narcissism and masochism – two situations that both have their pros and cons, their positives and their negatives – only then, I repeat, can we make sense of a multitude of clinical situations that affect emotion and that, while they may appear externally the same to the simple observer, for the analyst it is necessary to make a clear distinction as to the main origin of this influence. Situations that appear to be highly creative may have within them a very strong masochistic element while others that are apparently self-destructive (let us recall here Winnicott ‘s views on ‘Antisocial Behavior’) may promise great satisfactions because of the authenticity that is hidden in them.
In short, life and death are involved or, more precisely, intertwined in such a way that very often – if not in most cases – it is difficult to distinguish outside the analytic process to what extent the insufficiently socialized individual really desires the masochistic pleasure of continuing his life with all its negatives and to what extent he desires the narcissistic pleasure of his self-destructiveness with all its positives. As I said before , this is completely connected with the resolution or not of what we briefly call the Oedipus Complex.
In the case of the dream, the narcissistic, the other-destructive , the antisocial element, the element that brings the individual back deeply into himself, clearly predominates. Therefore, the analyst’s job could not be other than to promote the erotic dimension hidden in the dream, even if it contains its masochistic component. In the case of free association, the intrasubjective , self-destructive , incriminating element predominates.
Having discussed the relationship between the dream and the free associations of each patient, let us now come to the subject of the interpretation of dreams and free associations and of the relationship, I mean the interpretative relationship, that exists between the two. The analyst who interprets either a dream or a set of free associations of his patient must constantly bear in mind the relationship that exists between these two analytic situations.
Our basic position is that the dream is nothing more than an extreme form of free association and free association a consensual or, intermediate form of dream. Consequently, in the interpretation that the analyst makes, he must constantly – in addition to interpreting his patient’s dream – find the dream element of his associations and transform it – at least to some extent and gradually – into conscious dream states which he is again called upon to interpret. In this sense, the interpretation of free associations brings their content ever closer to the patient’s psychosis through his neurosis and allows it to manifest itself or rather to ‘unfold’ gradually and more clearly. This phenomenon or, this technique is called ‘regression within analysis’ . What happens, in this case, is that the patient is thrilled and dazzled – and secondarily frightened – during his gradual encounter with his most basic narcissistic needs, which takes place with the support of his analyst. This regression and the creation of a dream- like atmosphere through the patient’s free associations create new conditions for the next stage of his analysis.
Indeed, the next stage of analysis is that which will be expressed by the analyst’s interpretations and which will now be in the direction of reconstruction , having collected from the previous state of regression a treasure trove of narcissistic elements which patient and analyst will be able to use for an enlargement and broadening of the patient’s egoic elements. In this way, analysis leads to psychosis without psychosis . The whole process is equivalent to what Freud called systematic analysis at the level of free associations or, fragmentary interpretation at the level of a dream.
There is a clear paradox here that characterizes this entire interpretative process. The paradox lies in the fact that the development of the analysis, in order to be successfully realized, must first pass through narcissism, that is, through the death instinct which, through the enormous energy availability that it controls, is able to enrich the life instinct infinitely when it encounters it and always, within the framework of a permanent masochistic over-replenishment.
In the case of my patient’s dream that I mentioned above, since there were no direct but only free (indirect) associations in his dream, we can more easily see that these are in reality nothing more than dream situations that mask the patient’s own needs for defensive negotiation of his repressions but in a different way than that of the dream itself.
So my patient’s free associations in this session had to do with how he had spent his weekend at the house of a doctor friend who always conveys to him a feeling of confidence in himself because he feels that if he suffers a health problem ( e.g. a heart attack) he will certainly know how to deal with it, especially on the days he does not come for analysis. And yet – he continued to say – despite the enormous improvement he feels since he resumed intensive treatment and discontinued all medications, he has now developed inexplicable tearing that often puts him in an awkward position, especially on weekends. Jokingly, he continued that he would give anything to be able to overcome the tearing as well as the drooling that has appeared on his right side and often makes him think that he has had a stroke.
In the next two or three sessions I first interpreted to him and according to his associations on a transferential level always how much he thinks of me on the weekends when we don’t see each other and what a nice thing it would be if we were together even if it were just for rest. Then, neither his eyes would run nor would the stroke bother him but as in a dream only his lips would be owed to me, that would be my reward – that would be his debt to me. That is, I interpreted for my patient the intrasubjective , intraconflictual part of his associations that concerned the transference to a relaxed dream level – how his feelings about the weekend are explained – but including at the end of my interpretation the pure dream element, the completely unreal one, which was related to his ‘lips’ in the dream and which did not concern his feelings but a strange, distant dream image. It concerned the unpinned numbers of the dream 5×200 = ‘lips’.
My patient agreed that this sounded very ‘real’: it would undoubtedly be wonderful if we had formed a friendly relationship, because he had often thought that we should be similar in character. After all, after the end of the analysis he saw no reason why such a relationship could not exist! Specifically, he said that he had been thinking about it last weekend and even said that at the rate we were going, it seemed quite possible for the relatively near future. But what he did not understand, he continued, was about his lips. What did I mean by this? Did I mean something related to homosexuality? He reminded me that, as he had mentioned in the past, homosexuality was the most disgusting thing he could think of happening to himself or to any man. It was an inexplicable enigma to him how one could be homosexual! Did I mean to imply that he was gay? He felt he hadn’t understood what I said about the lips.
Then – and only then – when I had negotiated with the neurotic, the intrasubjective , the conflictual and the dreamy element of his free associations, I pointed out to him that this incomprehensible part referring to his lips exists in his thought and that he has completely cut it off , and we see it exposed in his dream where he refers to his debt to ‘euphoria’, that is, the pleasure he derives from our contact, which however stops at ‘the lips’ (‘2×500’). In order for this great and final satisfaction between us not to occur, a ‘policeman’ lurks from outside (a reference to his superego) who makes his analytic presence with me prolonged but prohibitive in the euphoria of oral contact.
This interpretation shocked him and affected him deeply. The tears disappeared from then on and he became noticeably less afraid in processing his homosexual moods. His improvement was rapid and to the extent that even his blood pressure returned, as he said, to normal levels without the use of antihypertensives , which he stopped. He felt that perhaps the analysis could also be stopped, although only I could know about such a thing!
However, I repeat that there were no direct associations in his dreams. Consequently, I interpreted to him in the transference, on the basis of his present associations and those I have mentioned above, how much he must feel that he is keeping secrets from me since the tearing and drooling stopped and what a difficult position he is in wanting to give me everything in order to be consistent with me and to keep nothing hidden from me anymore. However, the terror of such a development is so great that it is preferable for him to stop his analysis again. I added – again making use of the dream element of his free associations – his hypertension has now fallen and we are both relaxed and at the same level. He replied that things must be like this because he trusts what I tell him so much, but that last thing about hypertension sounds a bit outrageous.
I was of course aware of this. But having reached this point where again on the basis of his associations fantasy and transference reality had come so close with the help of the dream element of free associations, I now proceeded to interpret for him the second part of his dream itself which said in other words exactly the same thing. That is to say, I spoke to him about the second part of his dream where the level of our secret homosexual relationship in the hotel coincided with the public life of the main street. We were both motionless on a bed or on the deck of a main avenue. Psychoanalysis and everyday life no longer ceased to be two separate situations, we had almost reached the end, almost the death that such a reality would have in it. As a complementary part of my interpretation, I brought him what was happening in his dream with my weekly (at that time) salary of 375 E , which he wished to increase on his own to 400 E so as to break this formality between psychoanalysis and reality, hence his debt to me as well as the alleged mistake he had made at the time.
In this case, and given the complete inability of this patient to have direct associations in his dreams, we can, I think, easily see that his free associations contain the dream element and that by interpreting the core elements of the free associations as a dream, we not only more easily arrive at the interpretation of the real dream , if and when it exists, but above all we promote gradual regression and simultaneous awareness.
The difficulty that we see so often exists in the process of interpreting free associations at the dream level, that is, of promoting regression and interpreting neurotic- psychotic defenses at the level of transference, is clearly a matter of countertransference . Indeed, it is very common to see analyses which avoid the interpretations of free associations in dreamlike states – that is, they avoid the patient’s essential regression – with the result that we have an exhaustion of any given egoic reserves. Because these are anyway very limited during analysis due to their absorption by the abundance of egoic defenses which, in their attempt to become ego-resonant, exhaust themselves in the maintenance of this very neurosis. In practice, I think that what happens is that instead of regression, we have a promotion of the patient towards the side of anti-regression and the complexity of the defenses and instead of the ‘ex post’ interpretation, the split of a supposed non-existence of dream- psychotic processes in neurotic patients and non-existence of neurosis in psychotic patients is usually adopted . For this reason, I would say that it is not at all rare to observe a confusion of terminology among psychoanalysts, where ‘regression’ is defined as egoic disturbance due to repressed energy material, while in practice it is nothing more than the exhaustion of the patient’s already limited energy reserves that reach their limits.
This issue – that is, the issue of countertransference – has, as is well known, been studied and investigated in various ways. To the best of my knowledge, there has been no research on this issue from the perspective of the analyst alone and not the analysand. I am referring, in this case, to the studies that have focused exhaustively on the issue of projective identification without paying due attention to the metapsychological dimension of the issue of countertransference . For only when we see the analyst’s own inhibition to allow the patient’s regression through the use of his free associations on a dreamy and not just a pragmatic level , only then will we be able to discern the significance of the analyst’s intentions in the issue of projective identification, which are essentially nothing more than a ‘dreamy refusal of the analyst’ to help his patient in his regression .
In conclusion, I would say that only when we see the analyst’s inhibition in interpreting his clinical data on the basis of the dream elements of his patient’s free associations, only then can we draw clear conclusions about the effectiveness or otherwise of the analysis.
The patient’s regression through interpretation into a dream state and his recovery from it brings with it an enormous wealth of energy reserves and promises a newly emerging egoic functionality, which makes it a sine qua non of any psychoanalytic process. But this requires a corresponding course on the part of the analyst. The analytic attitude, that is, the attitude in which the analyst can dream simultaneously with his patient while at the same time possessing egoic reserves that his patient lacks, constitutes the culmination, in my opinion, of the attitude of each analyst. This means that the analyst allows himself to ‘regress without regressing’ with his patient.
This second paradox consists in the fact that the analyst has desexualized , that is, has drawn from his unconscious energy reserves the corresponding actively stimulating, instinctive , self-destructive and narcissistic dream content that is hidden in the free associations of his patient and in this sense he is not afraid of it . Here, then, is the real nature of countertransference from a metapsychological point of view. It is nothing more than a self-hedonistic disposition of the analyst and a limiting dimension of his desire to follow the dream path of his patient.
There is no doubt that it is extremely difficult for an observer to follow what happens within the psychoanalytic space between patient and analyst. There is no doubt that the ignorance of the need of each patient to leave the space of reality and to regress during his analysis while being sure that he will be able to hold on to it afterwards in order to return to a state of advanced functionality is something that is not controlled. This has been replaced, in the bibliography, with descriptions such as that the patient is ‘difficult’ or, psychotic structure, or, borderline or, psychosomatic and with a multitude of other conditions not excluding of course the hereditary predisposition of the patient. All of this, taken together, makes psychoanalysis an inactive or an ineffective form of psychological treatment. Perhaps, before we finally decide on psychoanalysis, we should examine what the psychoanalyst does during psychoanalysis.
Bibliography
Freud 1900 The Interpretation of Dreams
Freud 1925 Some Additional Notes on Dream-Interpretation as a Whole
Freud 1914 On Narcissism’ an Introduction
Freeman Sharpe Ella 1978 Dream Analysis
Grubrich-Simitis, Ilse. 2000 Int.J. P Metamorphoses of the Interpretation of Dreams
This article was part of the two-day symposium of the Institute of Classical Psychoanalysis entitled “Psychoanalytic Interpretation and Other Forms of Interpretation” in 2006. You can find the full archive of the two-day symposium on the Institute’s website here