True to the traditions of French psychoanalysis, IPI’s visiting guest speaker Alain Gibeault, formerly secretary general of the IPA, bases his theory and clinical practice on the metapsychology of Freud. He approaches the first interview with a new patient with four questions in mind.
- What kind of meeting is appropriate for this patient — psychoanalytical or something else?
- What indications are there that a psychoanalytic approach to treatment could be useful?
- How do patient and analyst work together in this interview?
- What has triggered the request for help?
Gibeault’s intention is to explore the conscious, pre conscious and unconscious layers of the mind. In keeping with Freud’s topographical approach, he assesses the psychic functioning, faces the emotional storm, and contains the affect that arises as he works to open a psychoanalytic space, giving access to the unconscious and tracing the structural connections between superego, ego and id.
When treating the psychotic patients he sees in a clinic attached to a hospital, Gibeault, inspired by Lebovichi who introduced psychodrama to France, expands his psychoanalytic technique by including a team of seven psychodramatists (a luxury we can hardly imagine in the USA). He also arranges for a psychiatrist to treat the patient as well, keeping medication, follow up, risk assessment, and medical responsibility separate from the psychoanalytic perspective. The point of the profusion of therapists is to spare the patient the threat of engulfment by a single object. Instead, the transference is spread laterally among psychoanalyst and psychodramatists and the task of containment is shared by the team. The introduction of such a third in this way reduces the threat and diminishes the defense of splitting as a defense against engulfment or intrusion by the single therapeutic object.
Neurotic patients can symbolize their distress and keep it internal and so we can treat them in private practice. Psychotic patients cannot do that and so they need a hospital setting and a team approach that includes psychodrama to create for them an external image for contemplation. These patients can address this externally created image more easily than trying to use words to reach insight, while dealing with the stress of looking at a single therapist. The psychodramatists take on the characters assigned to each of them by the patient but they do not wait for role induction. They spontaneously react in ways that do not try to recreate the patient’s experience. Instead they offer something different. This construction of something new in the third reduces the dissociation from which the psychotic patient suffers. Unlike Klein who teaches us to interrupt the negative transference in the first session, Gibeault recommends that we must respect idealization and only later interpret aggression. Only then is it possible to interpret the negative transference — which must be done before termination can be possible.
Submitted by Jill Scharff Saturday November 9th