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Addictions are as suitable for psychoanalysis or psychoanalytic therapy as many other conditions traditionally treated with these modalities. Patients with addictions run the gamut of mental health, and their analyzability depends upon their overall level of psychological junction, not their addiction. The factors that have led to an inappropriate aversion to analytic treatment of people with addictions are discussed.
La dépendance se prête aussi bien à la psychanalyse ou à la thérapie psychanalytique que bien d'autres états visés classiquement par ces traitements. Les clients victimes de dépendance peuvent présenter n'importe quel état de santé mentale et leur susceptibilité à l'analyse dépend de leur niveau global de fonction psychologique, et non de leur dépendance. Les facteurs ayant abouti à une aversion mal fondée du traitement psychanalytique des personnes victimes de dépendance sont abordés.
The psychoanalytic literature of the past 35 years, especially more recent contributions, as well as increasingly wide clinical experience, indicates that psychoanalytic psychotherapy or psychoanalysis is the treatment of choice for many patients with addictions. Nonetheless, an outdated view of psychoanalysis as ineffective and even inappropriate as a treatment for addiction persists in many quarters, including parts of the psychoanalytic community. This older view holds that people suffering with addictions are too ill to participate in an analytic process and that psychoanalysis is too non-directive for a problem that poses potentially life-threatening risks. These risks, it is said, make it necessary to directly address addictive behaviour in a way that is inconsistent with the neutral, exploratory, and timeless nature of the analytic process.
I will discuss the factors that have contributed to this mistaken traditional view of the role of psychoanalysis in treating addiction and will present a current perspective on these issues.
Misunderstanding the Psychology of Addiction
For the first half-century of psychoanalysis, addictions were seen largely as a direct expression of drive derivatives, and their suitability for psychoanalysis was considered poor. In his landmark 1945 textbook, Fenichel wrote that "Addicts represent the most clear-cut type of 'impulsives' . . . For them [the drug effect] means the fulfillment, or at least the hope of fulfillment, of a deep and primitive desire . . . they are fixated to a passive-narcissistic aim and are interested solely in getting their gratification"...