Psychoanalysis in long sessionsVéronique Caillat
Psychoanalysis in long sessions, introduced by Silvio Fanti in the 1950s with the name micropsychoanalysis, has its origins in Freudian psychoanalysis. It is an associative method of investigation of the psyche characterised by long sessions (daily sessions of three hours) and technical supports (the study, during the session, of personal documents such as photographs or correspondence). These practical innovations enhance the associative dynamic and facilitate verbalisation and abreactions. The psychic contents thus become analysable in the smallest detail and as far as the repressed elements at the unconscious level.
The innovations of psychoanalysis in long sessions specifically concern the free associations, the fulcrum of the method fine-tuned by Freud to decipher the inaccessible unconscious and its genealogical memory. These innovations amplify the field and depth of the associative process, endowing it with a rhythm ensuring its continuity throughout the analytical work. Highlighting the smallest details of current and past life, familial and ancestral, the innovations favour the working through of corporeal, psychoaffective and relational intimacy, connecting it physiologically to utero-infantile experiences and phylogenetic schemes, thus bringing out the repetitive lines.
Psychoanalysis in long sessions stimulates the passage to consciousness and potentially to awareness of pathogenic psychic formations and critical desires, as well as the defences these give rise to. Thanks to the work in long sessions, clarification of neurotic conflicts and equilibration of psychic tensions are made more rapidly and naturally, and in the global sense of a psychocorporeal homeostasis. The associative repercussions and clinical results obtained with this new method have made it possible to redefine numerous aspects of the Freudian theoretical model. Its metapsychology situates the psychic in a psychobiological dimension which gives Groddeck’s Id its true value, placing the individual and his/her energetic (structural) and dynamic (instinctual) bases in a universal model which Fanti called The Energy Organisation of the Void.
The long sessions
Sessions of an average of three or four hours every day or at least five times a week. Thus defined, the long sessions constitute the principal module of this method. The two characteristic parameters, duration and frequency, are complementary and give the associative dynamic a rhythm of its own.
Why sessions of three hours?
The analysand needs time to feel at ease in the analytical situation, leave his/her habitual space-time, gradually relinquish control, let him/herself go, accept the associations in the freedom with which they emerge and follow them through the associations of words. The apparently futile worries, daily annoyances, occasional small mishaps, including unforeseen events which may happen on the way to the session, can be recounted without the analysand attempting to short-circuit them in order to go straight to what he/she believes is essential. While verbalising these banal facts is often upsetting and can entirely take over a short session, in long sessions it sets off the associative process and makes it possible, generally without the analysand being aware of it, to connect the current material to the vital material.
To respect this associative space-time, all references to time are removed, including the analysand's watch before he/she lies down on the couch. Without concern for the passing minutes, the analysand can take all the time he/she needs to relive his/her story in detail, visualise it and linger there; can fully let him/herself go with his/her abreactions as well as his/her silences, especially the silences which correspond to the overcoming of a resistance, the assimilation of an intervention or a sudden insight.
During a three-hour session, rational thought, logical association, concern for the cognitive aspect, in short, the mental, give way more easily and more rapidly to the psychic and, above all, to the preconscious. Here, the free-associative thinking takes place and, nurtured by life and the manifestations of the unconscious, can materialise in verbalisation. This change in ideation depends, of course, on the insight and associative capacity of the analysand, his/her type of neurosis and the progress of his/her work. In this respect, it is interesting to note that with sessions of three hours, symptomatic obsessive neurosis no longer constitutes an analytical contraindication. In the long sessions, the mental circuits lose their rigidity and tend to open up; the slow working through of obsessions, rituals, control, doubt and inhibitions ends up making the defensive shell permeable; the representations emerge from their isolation-annulation, begin to circulate associatively and can rediscover their corresponding affect to express true emotions.
If, however, the three-hour session is the crucible of the transformation of mental ideation into psychic ideation, which makes possible the connection between the unconscious, the preconscious and the associative verbalisation, this transformation also presupposes the daily nature of the sessions. The associative ring, to which we shall shortly return, is for the analyst both demonstration and proof of the complementarity between the duration and frequency of the sessions.
Why daily sessions?
The three-hour sessions, held daily or at least five times a week, establish an associative rhythm which experience has shown to be the physiological respiration of the psyche. The sessions end up integrating naturally into the daily life of the analysand and even becoming its central element. This ensures that the analysand immerses him/herself more rapidly into the session and the intimacy of his/her material. Once established, this rhythm is maintained preconsciously from one session to the next, provided no more than a day passes between sessions. In this respect, we may recall the "Monday crust" mentioned by Freud to express the resistances induced in his patients by the weekend break. The associative rhythm reveals itself especially during dream analysis. For example, any daily detail, such as an associative sequence or a fragment of an intervention by the analyst, is used by the night-time dream-work, found again the following day in the telling of the dream (manifest content) and worked through in associative sequences which, in turn, nurture the dream of the following night… Thus, the same element can present itself, more or less worked though, in the dreams of several consecutive nights which join together to form a succession or genuine oneiric series.
Complementarity of duration-frequency of the sessions
The extent of this duration-frequency complementarity is shown with great precision in the associative ring, which begins to form when the analysand has become familiar with the analytical situation, assimilated the fundamental rule and entered a daily rhythm of work. On a first view, the associative ring can be seen in this way: one theme (topic, event, person, feeling…) amongst numerous others is evoked at the start of the session, followed by the associative working through where it is absorbed and often as such disappears, to then reappear after two or three hours of session, as it was or in the form of another theme whose working through has revealed its nature as a psychic, bodily, or affective equivalent. It is thus ascertained that the associative concatenation of the material has formed a ring.
On a second view, the associative ring reveals its sense through the equational work of the analyst. When listening with suspended attention, the analyst perceives the various themes verbalised by the analysand, follows their development, identifies the themes to which they lead, and follows their associative evolution. Ultimately, the analyst's work consists in highlighting series of significant or privileged themes within the pattern of the material, that is, themes which present preconscious connections and have equivalent value to the unconscious nuclear themes corresponding to specific utero-infantile experiences. The analyst's work is thus equational, in the sense that its objective is to discover, at the preconscious level, sequences of psychobiological equivalents with identical unconscious systems of reference. With this equational scheme, the associative ring may be considered according to the following: an initial theme develops associatively - giving rise to various others which in turn develop and form an associative pattern - from which significant or privileged themes emerge and become part of an equation of psychobiological equivalents, whose working through causes, after two or three hours, the initial topic or direct equivalent to reappear. At this point, the analyst knows that the repressed has been able to return, to pass through the censorships, and that aggressive or sexual manifestations have been able to blossom from their utero-infantile nuclei.
For the psychoanalyst in long-sessions, the associative ring is an extremely important point of reference. It is an indication of the appropriacy of the duration and frequency of the sessions and confirms the functional complementarity of the two parameters. It attests to the quality of the associative rhythm of the material, shows that the analysand is immersed in a wide and deep working through, and that the overcoming of resistences is taking place physiologically. Lastly, it is the proof that the equations form and that they ensure the connection between actuality, preconscious memory and unconscious memory.
The possibility of modulating the duration-frequency binomial
The possible modulations of the rhythm of work are part of the plasticity of this technique, that is to say, its capacity to take into account the analysand's personality, age and the particularity of his/her neurosis. In practice, if the aim is to maintain an associative rhythm which allows associative rings to form, the duration of the session should not be reduced and the analyst can change only the frequency, without, however, holding fewer than three weekly sessions.
Technical support is the study during the session by the analysand of various documents which closely or distantly concern his/her intimacy. During a complete psychoanalysis, the analysand studies descriptively, then associatively: 1) his/her family tree, made by him/herself; 2) personal and family photographs; 3) floor plans of places lived in since birth, drawn from memory; 4) his/her correspondence (in particular, romantic), and writings: diaries, school notebooks, travel notes, poems. Lastly, 5) particularly at the end of the analysis, some audio recordings made in sessions during the work are listened to. These technical supports are coadjuvants which need to be integrated into the long sessions in order to develop their psychic efficacy.
The long sessions and the technical supports are thus inseparable. They make up a whole which bestows cohesion and real consistency on the technical edifice of the psychoanalysis in long sessions. The long sessions give the technical supports an analytic reach by integrating them into a truly associative rhythm; while the technical supports, by stimulating, supporting, and enriching the associative dynamic, give a sign of reality to the current and past experiences verbalised by the analysand and favour the establishment of a temporal and psychocorporeal continuity on which the analysand will be able to position the appearance of his/her repetitions and phantasies. Leading the analysand to reconnect to internalised experiences, which originate from the major physiological functions, and to become familiar with the elements of his/her own sexual and aggressive intimacy as far back as their ancestral facets, the technical supports help to give back to the body the role and value ascribed to it by Freud: the body is the seat of our earliest vital needs and their satisfaction as well as their frustration, of our excitations, of our initial pleasures and displeasures, and it is the internalisation of all these corporeal experiences which is at the origin of the psyche, our repressed memory, the unconscious mechanics of our desires and their realisation, our defences and their systematisation, and our sexual and aggressive phantasies. It follows that the body, including the brain and the mental function, is constantly interacting with the psyche, and for this reason the drives are the vectors of the biopsychic and psychobiological translations.
From a practical point of view, a technical support is introduced at a precise moment during the analysis, depending on the type of material to be studied, the global dynamic of the work and the immediate associative context. In order to respect neutrality and avoid therapeutic preoccupation, symptomatology is not taken into account. Every technical support adheres to strict and specific rules on its use (which will not be dealt with here). Schematically, the study always takes place over two complementary stages: in the first hour, the analysand sits at a desk and observes and describes the documents in the smallest detail; in the following two (or more) hours, the session takes place as usual with the analysand on the couch letting him/herself go with the free associations. In order for there to be sufficient time for working through after the description, the session may be extended by an hour. The study of a technical support is generally carried out over ten-twelve consecutive sessions and may be resumed further on (which is always the case with the study of photographs).
The observation and detailed description of various types of documents place the analysand face to face with the totality of his/her life and that of his/her family. The analysand takes the time necessary to become familiar with the documents studied and enter, absorb and internalise the atmosphere they contain. Through detailed study, the analysand is gradually led to overcome his/her selective, focused and projective view - the source and result of prejudices - and to discover his/her origins, what his/her young parents were like, who his/her ancestors were. He/she reacquaints him/herself with his/her body as a newborn baby, follows his/her physical and character development and its relative changes and constants. He/she finds the similarities, mimicries and the more or less fleeting imbalances which he/she can place chronologically, or even causally. For example, starting from a series of photographs, he/she will be able to highlight a temporal correlation - allowing for a degree of divergence - between the beginning of a total withdrawal into him/herself and the withdrawal of cathexis by his/her mother, who suddenly becomes psychically absent, like an empty or dead mother. The analysand reimmerses him/herself also in the places he/she has lived, where the infantile experiences overseeing his/her internalisations, the basis of his/her psychobiological development, are impressed. The study of the correspondence relentlessly translates things and emotions into words, and may be of comfort to him/her in his/her experiences or, equally, may reveal inconsistencies or contradictions, or even secrets or things unsaid. It makes his/her states of mind and way of thinking an almost "live" experience, and often pinpoints the period when existential anguishes, phobic fears, depression or obsessive doubts began to manifest themselves. At the end of the work, the analysand enters his/her own corporeal, affective, mental and geographic intimacy more profoundly and acknowledges the aggressive and sexual tenor of the relationships with and between his/her relatives.
In other words, he/she repositions him/herself in his/her own personal and ancestral story and, beyond his/her substitutive reconstructions (which he/she will analyse) or the subjective information received from the people around him/her, becomes able to place it in a relatively objective reality, comprehend its constants and see the broad strokes of its onto-phylogenetic repetitions and the outlines of its phantasies.
For his/her part, the analyst greatly benefits from these pieces of information, which give his/her interventions a foundation and some references based on observed reality, thereby reducing and even excluding the risk of speculative reconstruction or improper interpretation.
However, the essential interest of a technical support lies in the associative working through which follows the phase of observation-description. Beyond the objective reality they reveal, the documents studied lead the analysand to an objectual reality, that is to say, to the internalised experiences which are the determining factors of the ontogenesis.
Through the associative rhythm they foster, the long sessions ensure that the data perceived during observation-description associatively and progressively integrate into the material as a whole. In effect, a technical support is not intended to arouse or provoke memories or abreactions, but to give a touch of coherence to a material which is being worked through. On the couch, the analysand can develop any element - often a tiny detail - which arose during the description, at first intentionally and then, little by little, without being aware of it, in accordance with an associative determinism. The element infiltrates the flow of free associations and becomes dilute, connecting with various life episodes, details from other technical supports, or fragments of dreams which can, thanks first to the sequences and then to the associative lines which they form, find their correspondences with certain experiences internalised during the utero-infantile period. For example, a detail of the kitchen floor plan of the analysand's infancy which comes up again in the associative material can lead back to repressed experiences of familiar and embracing smells or, vice versa, to those of greed or frustrating hunger, and cause the emergence of the corresponding desires of symbiotic union or, vice versa, those of oral aggressiveness or vendetta. It is precisely the fact of associatively placing an observed element in correspondence with an element coming from the unconscious that gives the document its existential weight.
The various technical supports end up completing each other, enriching the associative pattern: a detail from a photograph evokes a fragment of the correspondence, which leads back to a place in infancy, which recalls a genealogical facet… All these chains of information are introjected, converge and assemble by virtue of preconscious analogies, correlations, similarities and equivalences, to connect in the end to elements of unconscious reality. The true work of re-evocation is thus enhanced in its globality: an associative work which creates the memory rather than reactivating memories as such.
A past reconstitutes itself, or rather builds-rebuilds itself, connecting to the here and now, yet starting from true elements.
Conducting a psychoanalysis in long sessions
With the duration-frequency complementarity they introduce, the long sessions give the associative dynamic a rhythmicity and continuity which render the work more physiological. For their part, the technical supports reinforce this associative surplus value and add both coherence to the interactions between psyche, body, and reality, and cohesion between the onto- and phylogenesis.
The continuity and coherence guaranteed by such an apparatus tend to give the analysand security when facing unknowns and, ultimately, the mystery of a psychoanalytical undertaking. Without understanding exactly or rationally what is happening in him/her, the analysand knows that he/she is at the centre of a process whose underlying thread he/she can perceive. For the analyst, this apparatus offers sure points of reference and precise criteria regarding the progress of the work and the appropriacy of interventions made, thus allowing him/her to maintain his/her suspended attention and neutrality.
The main stages of a psychoanalysis in long sessions
The clinical and technical scheme of a psychoanalysis in long sessions makes itself very clear for the analyst: the stages, critical thresholds, breaks, detours and resumptions.
First stage: the story of the person
While familiarising him/herself with the analytical situation and trying to follow the associative logic of the fundamental rule, the analysand starts to recount his/her life, starting where or from what he/she wants. He/she learns to let him/herself go and to say whatever comes to mind, but with the pattern of his/her current and past life as the background. Little by little, he/she discovers the importance of details, at times in themselves but especially as elements connecting facts, places, people and feelings. The repetitive lines of his/her existence appear, trace their outlines and lengthen, ever more unexpected, hence the importance of making in session a rough draft of the family tree and visualising some photographs in order to fill out the key figures mentioned in the material. The associative continuity establishes itself, imparting a rhythm which tends to reverberate from one session to the next. The analysand's life story takes shape and gains consistency, his/her identity is outlined with its increments, shortcomings and voids.
A first period of a psychoanalysis in long sessions is the approach to a true self-knowledge, an unprecedented test of honesty which leads to re-evaluation of a good many preconceptions and prejudices. It may suffice to rebalance a slight neurosis, resolve current problems, or reduce anxiety, stress, or temporary fears or tensions. The associative verbalisation in the long sessions often makes it possible to avoid negative or unhappy repetitions, and this without the need for psychotherapeutic intervention by the analyst. This is why a first period of psychoanalysis in long sessions always proves to be positive and beneficial and, indeed, some people no longer feel the need to continue with their analytical work. In any case, this type of work is recommended before a determining commitment: a wedding, the decision to have a baby, a divorce, decisions over an inheritance, choosing or changing a profession… A first period is particularly recommended for women at the beginning of pregnancy in order to avoid endogenous or exogenous disturbances, or also for those who are apprehensive as senescence draws closer.
This first stage lasts on average 120-150 hours, and opens up naturally to current and vital material which takes psychocorporeal, relational and familial intimacy more and more into consideration.
Second stage: intimacy
The analysand becomes more personally involved in the associative work. His/her own nature begins to reveal itself, as do details of his/her private and professional life. He/she lets him/herself go, with more and more precise descriptions of his/her body, from both a behavioural and morphological point of view and one concerning habits in clothing, food, hygiene and health. This detailed description extends to his/her character and emotive and sentimental life. Sexuality takes advantage of this context to verbalise masturbations, love games and sexual intercourses. The first substantial dreams appear and daydreams allow the underlying phantasies to emerge. Transference elements naturally infiltrate this material and the analyst is projectively merged with certain important figures in the analysand's life. In this respect, the social relations between analyst and analysands (evening meals together at agreed intervals) assume great importance: they make it possible to leave the "quasi-real" dimension of the session and interact on a personalised level.
Through the study of the photographs and, if already studied, the floor plans, all this intimacy becomes slowly included in lines of repetitions which lead back to infancy and the oedipal relationship.
Third stage: the Oedipus complex
The associative in-depth study of the psychocorporeal intimacy up to the utero-infantile and phylogenetic experiences lay bare Oedipus. In the long sessions, Oedipus is not resolved in the famous child-mother-father triangle, but in an interactive whole of aggressive and sexual drives and desires, taboos and defences, love and hate with their innumerable equivalents (fidelity, jealousy, rivalry, revolt, vendetta…). Indeed, if it is true that oedipal bipolarity exists, with an incestuous pole (the desire to possess or be possessed, to make love, to penetrate or be penetrated, to have or make a baby) and a killing pole (the desire to kill in various ways), the material in the long sessions demonstrates that these two poles are not as unilaterally determined as they are claimed to be. On one hand, they interact and present facets which are combined or in conflict; on the other, the incestuous and homicidal impulses of male and female can, at least in part, be directed to the same parental pole. It is in this sense that Oedipus is a complex and that the relative importance of its various elements needs to be accurately highlighted in order to be able to evaluate the particularity and intensity of the desires in play. All these desires clash with powerful phylogenetic taboos, transgression of which means exposure to the risk of castration.
With Oedipus and castration, we are at the heart of the phallic stage, which constitutes the basis of genitality and delineates our future substitutes. But at this stage of the work, phallic castration can only hint at its working through, since its initial repression is found in the primary mother-(foetus) child relationship. In this way, starting from Oedipus, the line of working through naturally orients itself towards the mother of the first eighteen months, short-circuiting the anal stage. Indeed, it becomes evident that the themes linked to the maternal nucleus, such as possessiveness, jealousy, dependence, abandon, exclusion and annihilation, become predominant. This short circuit contravenes the Freudian scheme of an analysis carried out geologically following the ontogenetic stages from the most recent layers to the oldest: phallic - anal - oral. And while in the long sessions it develops physiologically, outside this context it poses often unresolvable questions. In any case, there is no point forcing the issues of castration and the anal stage until the maternal complex has been worked through.
Fourth stage: the maternal complex
This is the matter of the interactions between the embryo-foetus and the uterine mother (initiatic stage), the experience of birth and the relationship of the child with the mother in the first fifteen months (oral stage). Depending on the maternal characteristics arising from the oedipal working through, the associative development will be more in the sense of the component of defusion (from six to twelve months) and allow the emergence of experiences of rejection, abandonment, or exclusion, like phantasies-desires of cannibalistic destruction; or it will be in the sense of fusion (up to six months) and will stimulate experiences of dependence, or possessiveness-jealousy, like phantasies-desires of annihilation. Afterwards, these lines of working through converge on birth, in particular on the circumstances and conditions of delivery. If, in retrospect, birth can represent a liberation, the delivery consists in an often-bloody fight at close quarters between the mother and her child-penis, separation from which can only take place ambivalently. Here we touch the fundamental traumatic experience of the child, who was conceived and unconsciously considers him/herself the penis of his/her mother but at the same time perceives that the mother is without one. This is an existential dilemma, since "if my mother has no penis, I do not exist". The working through of what P. Codoni calls primary castration will allow the analysand to return associatively to phallic castration, re-permeabilise Oedipus and physiologically enter the anal stage.
Fifth stage: the anal dynamic
The anal dynamic is the most resistant to analytic investigation, as it brings into play instincts to master and processes of control which are highly aggressive because they must ensure a pyschocorporeal opening up of the child to the world and to others, the equivalent of a radical change of identity: the passage from the stage of fusion-defusion and narcissism to the state of a person in all respects. Now, the system of drives must strictly regulate, on one hand, the survival of the child, its security and self-preservation, and the sphincteric mastery of the body's orifices (sense organs included) which maintains the balance between the inside of its body and the outside and, on the other hand, with regard to the psyche, it must regulate the internalisation of experiences and their memorisation in the unconscious. The child's vital aggressivity, highly stimulated to come out of its total dependence and to preserve its autonomy, tends to race or become blocked, which determines the setting up of a highly sophisticated defence apparatus which involves isolation, to better exercise control and avoid the loss of control which activates the fear of castration and of dying; undoing, to attempt to eliminate the limits implied by isolation; and reaction-formation, to diametrically oppose control and isolation. All this complex yet extremely precise mechanism lays the foundation for systematised obsessive neurosis or one of its minor variants: failure neurosis, character neurosis, or obsessive compulsive disorders. The anal mechanism is so strong and so vitally necessary that it infiltrates the oral-initiatic stage retroactively and the phallic stage anteroactively.
The tangle of the aggressivity of mastering, especially in its form of sphincteric control, and anal erogenicity is expressed in sado-masochism: sexual pleasure or gratification deriving from pain inflicted or suffered in psychocorporeal domination which may go as far as reification. The sadistic and masochistic components are interdependent. Highly detailed description of the daily material raises awareness of the subtleties employed to exacerbate the sadism of others with the aim of discharging personal masochistic drives.
Practical schemes of a psychoanalysis in long sessions
Taking into account the main stages characterising the associative development of the work in long sessions, two practical schemes to a psychoanalysis in long sessions may be considered: continuous and in periods.
Continuous psychoanalysis in long sessions
Ideally, this can be done in about a year. It is an extraordinary experience, possible in cases of slight, well-balanced neuroses, during which there is no need for a specific time for sedimentation between one stage and another to recover energy and stabilise.
Continuous psychoanalysis in long sessions usually entails three periods of work separated by two rest phases for sedimentation and reconnection with the socio-affective and professional reality. In such a scheme, which is realisable in two years, the frequency of the sessions can if necessary be reduced to a minimum of three a week, provided the associative rhythm is not disrupted as a result. This type of analysis is suitable for people who need a certain mothering or respond badly to ruptures, in particular, those with dependence syndromes, manic depressives, schizophrenics in a non-acute phase, borderline cases and those with recurrent depression.
Psychoanalysis in long sessions in periods
This is the most physiological scheme, especially if a commitment to a total duration of five years can be made. It also best meets the obligations of modern life. The periods of 120-150 hours adapt naturally to the major stages and phases of carrying out an analysis in long sessions. For example, 150 hours is generally enough to obtain the associative story of the analysand and its main repetitive lines (first stage), to enter his/her psychorporeal intimacy sufficiently to see the two oedipal poles begin to show themselves (second stage) and to analyse in depth the Oedipus complex (third stage). The maternal complex (fourth stage) and above all the anal dynamic (fifth stage), however, require more time and in ideal conditions can be analysed in two or three periods of 120 hours each. Each period is followed by time for sedimentation of six to nine months, during which the analysand can, if necessary, do a few maintenance sessions to take stock of the situation or to analyse a dream of particular concern, a repetition which poses a problem or any other question which seems important.
With its practical innovations, psychoanalysis in long sessions is committed to both the continuity of the Freudian work, centred on associative thinking and on the willingness of the analyst, and the need for long sessions required by a psychoanalysis carried out in depth.
A version of this article was published in Nervure - Journal de Psychiatrie, No. 3 - Vol. XXI, 04/2008, pp 14-17, under the title "La micropsychanalyse".