Panel on What is Psychoanalysis?

Susana I. Martinez: The Uniqueness of Psychoanalysis

Almost every psychoanalyst would agree that what makes psychoanalysis unique among the different psychotherapies is that it inquiries into human motivation, in particular, unconscious motivation. Indeed, from the time Sigmund Freud invented this unique discipline, psychoanalysis has sought to understand the unconscious processes that organize conscious actions, thoughts, and feelings.

Of course, to inquire into unconscious motivation means to ask what constitutes the unconscious. While Freud lay the foundation to this question and posited a series of answers, by no means did he have the last word. From the time when Freud published The Interpretation of Dreams, in 1900, to this day, the question “What is the unconscious?” has remained hotly debated.

That this important question has not been answered in a definitive way is by no means to the detriment of psychoanalytic theory and practice. On the contrary, it speaks to its continuous vitality. For, in trying to meet the clinical challenges they face, psychoanalysts are compelled to look for new answers when existing theory falls short of this task. This leads to frequent theoretical revisions, which, to be sure, makes for a messy discipline: different people hold different theories and ways of practicing psychoanalysis that may not be compatible with each other. In my view, this state of affairs is not only desirable but also necessary. Human motivation is awesomely complex, and no single psychoanalytic theory can claim to account for the whole of human motivation, especially unconscious motivation. As one wise supervisor once told me, it is important to read far and wide, regardless of each author’s theoretical and technical tendencies, for you never know when in one of those readings you might find something that helps you better understand and help a patient. Vive la différence!

Inquiring into unconscious motivation is not the only thing that makes psychoanalysis unique. In its contemporary form, part of psychoanalysis’ uniqueness lies in that it is also interested in finding the best possible way to help a patient formulate her subjective experience, thereby expanding her self-awareness as well as the field of exploration. To do this, psychoanalysts use the empathic stance, that is, the capacity to imagine and feel their way into the inner life of another person. Without an empathic stance, there is no way to understand unconscious motivation.

Psychoanalysis is unique in another way: it focuses on understanding, creating and transforming meaning. By helping articulate our patients’ experience we are also helping appreciate its multiple and complex meanings and thereby create the possibility to transform such meanings.

Another unique aspect of psychoanalytic theory is that it reflects upon what constitutes the therapeutic action. For psychoanalysts, it is not enough to know that their patients get better; it is also important that they account for how that occurs. Once again, the different theories will vary on this point, but, again, this only enriches our theory and practice.

Finally, psychoanalysis is unique in that it puts the relationship between analyst and analysand at the center of the treatment. As psychoanalysts, we understand that the connection between analyst and analysand and the capacity to explore the dynamics of this connection are crucial for the therapeutic action. This requires that the analyst not only focus on the patient’s experience, but on her own as well. She must always be self-reflecting and self-aware of her own affective states, her motivation, her blind spots, and, most importantly in my view, her impact on the patient and her contribution to the therapeutic process, for better and for worse.

As I’ve had the opportunity to continue to work with patients, participate in study groups, peer supervision groups, and teach, I have become keenly aware of how unique it is what we do and what an incredibly rich tradition we belong to. As a result, I have come to feel not only proud to call myself a psychoanalyst but also have a sense of privilege of being part of this extraordinary discipline, community, and practice.