Outline 7

Nama:Arlina Sari
NIM : 0106522018
OUTLINE PENDEKATAN & TEKNIK KONSELING

PROGRAM STUDI MAGISTER BIMBINGAN KONSELING UNNES
A. Peta Konseptual Teori & Pendekatan Konseling

No Aspek Deskripsi Referensi
1 Nama Teori & Pendekatan konseling psikoanalisis
Pendekatan Konseling
2 Tokoh Pengembang teori Sigmund Freud
3 Konsep Dasar: a. Hakikat manusia 1. Gladding T.
Samuel. (2022).
a. Hakekat manusia manusia pada dasarnya bersifat deterministik. Menurut Pendekatan konseling
Teories of
b. Konsep Kepribadian & psikoanalisis, hakikat manusia ditentukan oleh kekuatan irasional, motivasi tak sadar, Counseling. British
Library
Perkembangan dan dorongan biologis dan insting saat ini berkembang melalui tahap psikoseksual
Cataloguing in
utama dalam enam tahun pertama kehidupan. Publication
Information
b. Konsep Kepribadian & Perkembangan
Available. London.
Menurut pandangan psikoanalitik Freudian, kepribadian terdiri dari tiga sistem: id, ego, 2. Corey
Gerald.(2017).
dan superego. Tiga sistem kepribadian ini merupakan struktur psikologis dan tidak
Theory and
boleh dianggap sebagai manikin yang mengoperasikan kepribadian secara terpisah; Practice of
Counseling and
kepribadian seseorang berfungsi secara keseluruhan daripada sebagai tiga segmen yang
Psychotherapy,
berbeda. Tenth Edition.
Cengage Learning.
USA.
Nama:Arlina Sari
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- Id adalah sistem kepribadian yang asli; saat lahir seseorang adalah semua id. Id
adalah sumber utama energi psikis dan pusat insting. Id diperintah oleh prinsip
kesenangan, yang ditujukan untuk mengurangi ketegangan, menghindari rasa sakit,
dan mendapatkan kesenangan, id bersifat tidak logis, amoral, dan terdorong untuk
memenuhi kebutuhan instingtual. Id sebagian besar tidak disadari, atau di luar
kesadaran.
- Ego adalah struktur kepribadian yang berfungsi dalam mengatur, mengontrol, dan
mengatur kepribadian. Ego mengendalikan kesadaran dan melakukan sensor.
Diperintah oleh prinsip realitas, ego melakukan pemikiran yang realistis dan logis
serta merumuskan rencana tindakan untuk memenuhi kebutuhan. Ego, sebagai
pusat kecerdasan dan rasionalitas, memeriksa dan mengendalikan dorongan buta
dari id. Sementara id hanya mengetahui realitas subjektif, ego membedakan antara
gambaran mental dan hal-hal di dunia luar.
- Superego merupakan struktur kepribadian yang mencakup kode moral seseorang,
perhatian utamanya adalah apakah suatu tindakan itu baik atau buruk, benar atau
salah. Superego mewakili nilai-nilai tradisional dan cita-cita masyarakat yang
diturunkan dari orang tua kepada anak-anaknya. Ini berfungsi untuk menghambat
impuls id, membujuk ego untuk mengganti tujuan moralistik dengan tujuan yang
realistis, dan berjuang untuk kesempurnaan. Sebagai internalisasi standar orang tua
dan masyarakat, superego terkait dengan penghargaan dan hukuman psikologis.
Nama:Arlina Sari
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Imbalannya adalah perasaan bangga dan cinta diri; hukumannya adalah perasaan
bersalah dan rendah diri.
4 Proses Konseling a. Tujuan proses konseling:
(Tujuan & tahapan Tujuan akhir dari proses konseling psikoanalisis adalah untuk meningkatkan fungsi
umum) adaptif, yang melibatkan pengurangan gejala dan penyelesaian konflik. Dua tujuan
terapi psikoanalitik Freudian adalah untuk membuat ketidaksadaran menjadi sadar dan
untuk memperkuat ego sehingga perilaku lebih didasarkan pada kenyataan dan bukan
pada keinginan naluriah atau rasa bersalah yang tidak rasional.
Dari asumsi di atas dapat disimpulkan bahwa tujuan dari Proses Konseling pendekatan
psikoanalisis ini tidak terbatas pada pemecahan masalah dan mempelajari perilaku
baru. tetapi untuk mengembangkan tingkat pemahaman diri yang dianggap perlu untuk
perubahan karakter. Terapi psikoanalitik berorientasi pada pencapaian wawasan, tetapi
bukan hanya pemahaman intelektual
b. Tahapan umum
- eksplorasi berulang dan rumit dari materi dan pertahanan bawah sadar, yang
sebagian besar berasal dari masa kanak-kanak.
- menerima struktur pertahanan mereka dan mengenali bagaimana mereka mungkin
telah melayani suatu tujuan di masa lalu
- menghasilkan resolusi pola lama dan memungkinkan klien membuat pilihan baru
Nama:Arlina Sari
NIM : 0106522018
- klien mengembangkan hubungan dengan terapis pada saat ini yang merupakan
pengalaman korektif dan integratif
- Jika fase hubungan terapeutik yang menuntut ini tidak berhasil dengan baik, klien
hanya mentransfer keinginan kekanak kanakan mereka untuk cinta dan
penerimaan universal kepada figur lain.
5 Teknik Spesifik Enam teknik dasar terapi psikoanalitik adalah:
Pendekatan (1) mempertahankan kerangka analitik
(2) asosiasi bebas
(3) interpretasi
(4) analisis mimpi
(5) analisis resistensi
(6) analisis transferensi.
6 Kajian Empirik Visentini guenael. (2020). Lines of approach for a theory of care/cure in psychoanalysis.
Efikasi/efektivitas
Pendekatan di seting Result: Mengingat dua kendala ini, psikoanalisis Freudian memberikan pendekatan holistik
Pendidikan dan integratif. Berfokus pada dimensi psikodinamik, ia menawarkan perawatan yang
disesuaikan, pragmatis, inventif, dan mengejutkan yang efisiensinya saat ini dapat diukur.
Sekalipun konsepnya adalah bagian dari ilmu manusia (dan bukan eksperimental), inilah
mengapa psikoanalisis tetap menjadi alat referensi yang menarik bagi dokter dalam pelatihan
dan sebagian besar praktisi yang paling berpengalaman.
Nama:Arlina Sari
NIM : 0106522018
7 Diferensiasi dengan a. Keunggulan & dibanding teori lain:

Teori/Pendekatan lain Psikoanalisis memiliki beberapa penekanan yang unik. Pertama, pendekatan
a. Keunggulan & Psikoanalisis menekankan pentingnya seksualitas dan ketidaksadaran dalam perilaku
dibanding teori lain manusia. Sebelum teori ini, seksualitas (terutama seksualitas masa kanak-kanak)
b. Kritik terhadap teori ditolak, dan sedikit perhatian diberikan pada kekuatan bawah sadar. Pendekatan
psikoanalisis telah memberikan dasar dukungan teoritis untuk sejumlah instrumen
diagnostik. Beberapa tes psikologi, seperti Thematic Apperception Test dan Rorschach
Ink Blots, berakar pada teori psikodinamik. Pendekatan psikoanalisis memiliki fokus
pada kompleksitas kehidupan dan sifat manusia. Pendekatan psikoanalisis efektif bagi
individu yang menderita berbagai gangguan,yang meliputi: histeria, narsisme, reaksi
obsesif-kompulsif, gangguan karakter, kecemasan, fobia, dan kesulitan seksual.
psikoanalisis dan psikodinamik menekankan pentingnya tahap pertumbuhan
perkembangan.
b. Kritik terhadap teori
Banyak kolega Freud dan para ahli lain, dan kemudian publik, yang menolak teori
psikoanalisis dengan penekanannya pada pentingnya seksualitas dan agresi dalam
etiologi kepribadian. Kritik lain pada teori psikoanalisis adalah bahwa pendekatan
psikoanalisis menantang peneliti untuk mengembangkan metode inkuiri yang canggih.
Nama:Arlina Sari
NIM : 0106522018
B. Analisis Kritis Jurnal (internasional)
Pendekatan/teori konseling : Psikoanalisis

Judul Artikel : Lines Of Approach For A Theory Of Care/Cure In Psychoanalysis
Hasil Analisis Kritis :
1. Deskripsikan tujuan penelitiannya?
Jawab: Untuk mengklarifikasi operator konseptual dari teori perawatan / penyembuhan psikoanalitik, dan untuk menempatkannya
dalam kaitannya dengan pendekatan lain - berfokus pada otak, gejala, atau pengalaman individu.
2. Deskripsikan fokus pada populasi/kelompok konseli yang dijadikan subjek penelitian?
Jawab: Psikiater dan psikolog yang menyelaraskan diri dengan gerakan "berbasis bukti", perawatan yang paling sah adalah pendekatan
terapeutik yang kemanjurannya telah ditunjukkan dalam pengaturan eksperimental. Sekelompok protokol terapeutik yang menargetkan
gejala spesifik, yang dirancang khusus untuk memenuhi kondisi lingkungan pengujian, sehingga cenderung lebih disukai (terapi
perilaku-kognitif, skema, eksposisi melalui realitas virtual, mentalisasi, penerimaan dan keterlibatan, meditasi mindfulness, EMDR) .
3. Deskripsikan lingkup teori konseling yang mendasari riset tersebut?
Jawab: Menghadapi perubahan di bidang kesehatan mental di abad ke-21 bagaimana mungkin psikoanalisis, yang fundamental
klinisnya berasal dari abad yang lalu, masih sangat didukung di institusi perawatan kesehatan mental, diajarkan di universitas, dan
dihargai oleh para praktisi muda selama studi mereka. Dalam arti tertentu, ada sesuatu yang membingungkan. Apakah itu tidak lebih
dari sisa-sisa posisi historis dominasi institusional psikoanalisis, seperti yang disarankan beberapa orang. Dalam pengertian ini,
psikiater dan psikolog yang berorientasi analitis akan menyalahgunakan otoritas klinis yang telah jatuh dari kasih karunia. Tetapi apakah
psikoanalisis, dalam sejarahnya dan dalam bentuknya yang lebih baru, masih mampu menawarkan teori pengobatan yang tidak hanya
Nama:Arlina Sari
NIM : 0106522018
masuk akal secara etis, tetapi juga dapat dipertahankan secara ilmiah, dihadapkan pada penderitaan "mental" perempuan dan laki-laki
kontemporer.
4. Bagaimana pelaksanaan atau prosedur penelitiannya?
Jawab: memperhatikan praktik klinis dan berdasarkan pembacaan ulang laporan kasus dari karya lengkap Freud (1886–1939), ekstraksi
"skema operasi" psikoanalisis Freudian, dipahami sebagai bentuk baru psikoterapi. Hasil Ini "skema operasi" dapat dibagi menjadi dua
kelompok, sesuai dengan dua wajah dari praktek Freudian: skema "merawat" (perawatan) dan skema "tindakan perawatan"
(menyembuhkan). Yang pertama memungkinkan perhatian klinis pada universalitas, tipikal, dan keunikan setiap pasien. Yang kedua,
memungkinkan identifikasi pemicu dan asal usul gangguan, berfungsi sebagai titik dukungan dinamis untuk perbaikan kondisi, bahkan
pemulihan dalam arti psikis.
5. Deskripsikan metode penelitian yang digunakan (kuantitatif, kualitatif atau gabungan)?
Jawab: Metode Penelitian Kualitatif
6. Berikan Deskripsikan dan argumentasi hasil penelitiannya & implikasi temuannya/hasilnya bila diterapkan di Indonesia (gunakan
analisis dan argumentasi saudara)
Jawab: Psikoanalisis Freudian memungkinkan pendekatan holistik dan integratif. Berfokus pada dimensi psikodinamik, ia menawarkan
perawatan yang dibuat khusus, pragmatis, inventif, dan mengejutkan, yang efisiensinya sekarang terukur dan terukur. Ini mungkin
mengapa, meskipun konsepnya berada di bawah ilmu manusia (dan bukan ilmu eksperimental), psikoanalisis tetap menjadi referensi
yang menarik bagi dokter dalam pelatihan dan untuk sebagian besar praktisi yang paling berpengalaman. Implikasi dari hasil temuan
penelitian ini dapat dijadikan sebagai referensi untuk diterapkan di Indonesia sebagai arah keterbaruan pengembangan model yang
dapat dikembangkan dalam bidang medis, khususnya di Indonesia.
*Lampirkan Artikel yang saudara kritisi

Nama:Arlina Sari
NIM : 0106522018
C. Analisis Kasus
ANALISA KASUS DONA
Dona adalah seorang perempuan berusia 39-tahun, ia telah menikah dan mempunyai empat anak remaja. Dona datang untuk terapi
pertamanya ketika ia mengalami kecemasan dan keluhan somatik. Dia tinggal bersama suaminya (Hamish, berusia 45 tahun) dan anak-anak
mereka (Dilan, 19; Milea, 18; Isyana, 17; dan Jaz, 16). Berikut adalah data ringkasan yang secara singkat didapat selamat proses wawancara
konseling dengan Dona.
a. Sejarah Psikososial
Dona adalah anak tertua dari empat bersaudara. Ayahnya adalah seorang tokoh agama yang fundamentalis, dan ibunya adalah seorang
ibu rumah tangga. Ia tidak memiliki hubungan yang dekat dengan ayahnya yang mempunyai sifat otoriter dan kaku, sehingga ia merasa
takut jika tidak dapat memenuhi semua tuntutan dan harapannya. Dona memandang ibunya sebagai seseorang yang kritis, dan ia berfikir
apapun yang ia lakukan tidak pernah cukup untuk membuat ibunya bahagia, walaupun terkadang ibunya menunjukkan sikap mendukung
terhadap apa yang ia lakukan. Ayah dan ibunya menunjukkan sedikit kasih sayang dalam keluarga. Seringkali Dona mengasuh adik-adiknya
hanya untuk mendapatkan perhatian dan kasih sayang orang tuanya. Ketika ia melakukan sesuatu yang ia senangi, ia mendapatkan
penolakan dan kemarahan dari ayahnya. Hal itu turut membentuk pola hidupnya yang lebih mementingkan orang lain daripada dirinya.
b. Identifikasi Masalah
Secara umum Dona merasa tidak puas dengan kehidupannya. Ketika menginjak usia 39 tahun, ia panik dan merasa telah menyia-nyiakan
hidupanya selama ini. Selama 2 tahun ia mengalami berbagai keluhan psychosomatic, seperti gangguan tidur, kecemasan, pusing, jantung
Nama:Arlina Sari
NIM : 0106522018
berdenyut kencang, dan sakit kepala. Ia mudah menangis karena hal sepele, sering merasa tertekan, dan tidak menyukai tubuhnya. Saat itu
ia memilih untuk meninggalkan rumah.
Dona menyadari bahwa ia hidup untuk orang lain, bukan untuk dirinya sendiri dimana ia memaikan peran sebagai “superwoman” dalam
semua aspek kehidupannya, namun tidak jarang melupakan keperluan dan keinginannya sendiri. Dalam sebuah hubungan Dona merasa
bahwa ia menjadi pihak yang selalu berkorban dan pada akhirnya membuat ia merasa hampa. Dia mempunyai kesulitan untuk meminta
bantuan kepada orang lain. Ia berusaha untuk menjadi istri dan ibu yang baik yang sesuai dengan harapan keluarga dan dirinya. Pada
beberapa kondisi, Dona merasa tidak menjadi diri sendiri. Ia tidak menyukai penampilan dan tubuhnya, serta kekhawatiran tentang harapan
keluarganya.
c. Latar belakang masalah
Pekerjaan utama Dona adalah sebagai ibu rumah tangga sampai anak-anaknya beranjak remaja. Ia kemudian melanjutkan perguruan tinggi
dan memperoleh gelar sarjana pada program studi perkembangan anak. Saat ini ia menjadi guru sekolah dasar, namun ia merasa terbebani
oleh keraguannya keinginan untuk mencapai karir yang lebih tinggi. Melalui komunikasi dengan rekan sejawatnya di Universitas, ia
menyadari bahwa ia telah membatasi dirinya sendiri, bagaimana keluarganya memperkuat ketergantungan terhadap dirinya, ia juga
menyadari bagaimana perasaan takutnya keluar dari zona nyaman sebagai seorang ibu dan istri. Ia juga mengikuti pelatihan konseling yang
membantunya dapat melihat lebih baik ke arah dirinya sendiri. Pelatihan dan pengalamannya dengan sesama pelajar yang bertindak sebagai
katalis membuat Dona dapat lebih jujur melihat hidupnya. Pada titik ini Dona menyadari bahwa ada hal yang perlu ia sadari lebih baik
selain menjadi seorang ibu, seorang istri, dan mahasiswa. Ia menyadari bahwa ia tidak mempunyai pengertian yang baik tentang apa yang
dia inginkan untuk dirinya sendiri, dan juga bahwa ia biasa hidup dari apa yang diinginkan oleh orang lain.
Kriteria analisis kasus adalah:

a. Ketajaman intepretasi dikaitkan dengan pendekatan yang dipakai (konsep dasar, hakikat manusia, dengan asumsi perilaku bermasalah),
Nama:Arlina Sari
NIM : 0106522018
Jawab:
- Konsep dasar: jika dilihat dari gambaran kasus di atas, dapat dianalisis bahwa kasus tersebut merupakan gambaran dari pendekatan
psikoanalisis yang dikembangkan oleh Freud. Ada gejolak antara keinginan Dona untuk mewujudkan ekpekstasinya terhadap dirinya
sendiri dan keinginannya untuk memenuhi ekpektasi orang lain. Asumsi ini berarti bahwa kasus yang dialami oleh dona dipengaruhi
oleh adanya pengaruh id, ego, dan superego.
- Hakikat manusia: Sifat manusia pada dasarnya bersifat deterministik. Menurut Freud, perilaku kita ditentukan oleh kekuatan irasional,
motivasi tak sadar, dan dorongan biologis dan insting saat ini berkembang melalui tahap psikoseksual utama dalam enam tahun pertama
kehidupan. Dari beberapa penjelasan kasus di atas dapat dianalisis bahwa masalah yang dialami oleh Dona saat ini dipengaruhi oleh
pengalaman-pengalaman masa lalunya.
- Asumsi perilaku bermasalah: Pendekatan konseling psikoanalisis memandang masalah sebagai konflik intrapsikis yang berkaitan
dengan kepuasan kebutuhan dasar. Psikologi ego tidak menyangkal peran konflik intrapsikis tetapi menekankan perjuangan ego untuk
penguasaan dan kompetensi sepanjang rentang hidup manusia. Pendekatan objek-relasi didasarkan pada gagasan bahwa saat lahir tidak
ada perbedaan antara orang lain dan diri sendiri dan bahwa orang lain mewakili objek pemuasan kebutuhan bayi.
b. Kemungkinan langkah treatment atau intervensi pada kasus tersebut.
Jawab: Teknik terapi psikoanalitik yang ditujukan untuk meningkatkan kesadaran, menumbuhkan wawasan tentang perilaku klien, dan
memahami makna gejala. Terapi dimulai dari pembicaraan klien ke katarsis (atau ekspresi emosi), ke wawasan, hingga bekerja melalui
materi yang tidak disadari.
Nama:Arlina Sari
NIM : 0106522018
LAMPIRAN
L’évolution psychiatrique 85 (2020) e15–e32
Disponible en ligne sur www.sciencedirect.com
ScienceDirect
et également disponible sur www.em-consulte.com
Opening
Lines of approach for a theory of care/cure in

psychoanalysis夽,夽夽
Esquisse d’une théorie du soin en psychanalyse
Guénaël Visentini (Clinical psychologist, Instructor and
researcher at the Université de Paris) ∗
CRPMS, 5, rue Thomas-Mann, 75013 Paris, France
a r t i c l e i n f o A b s t r a c t
Keywords: Objectives. – “Mental health” is a crucial issue for today’ societies.

Psychoanalysis But the clinical status of the disorders under consideration is up
Care for debate, thereby complexifying the decision of which therapies
Cure
to recommend. This article is in dialogue with the current con-
Psychodynamics
troversies. Its objective is to clarify the conceptual operators of a
Metapsychology
Typology psychoanalytical theory of care/cure, and to situate them in rela-
Etiology tion to those of other approaches – focused on the brain, symptoms,
Therapy or individual experiences.
Neuroscience Method. – Drawing on an epistemological perspective attentive to
Symptom-centered clinical practices and basing my reflection on a review of the case
Freud reports in Freud’s complete works (1886–1939), I propose to extract
the “operational schemas” of Freudian psychoanalysis, seen as a
renewed form of psychotherapy.
夽 Translated by Emily Lechner, clinical psychologist, 118, avenue du Général-Leclerc 75014 Paris (lechneremily@gmail.com).
夽夽 Any reference to this article must mention: Visentini G. Esquisse d’une théorie du soin en psychanalyse. Evol psychiatr
2020; 85(1): pages (for the paper version) or URL [date of visit] (for the online version).
∗ Corresponding author.
E-mail address: guenael.visentini@yahoo.fr
https://doi.org/10.1016/j.evopsy.2020.01.005
0014-3855/© 2020 Elsevier Masson SAS. All rights reserved.
e16 G. Visentini / L’évolution psychiatrique 85 (2020) e15–e32
Results. – These “operational schemas” can be divided into two

groups, according to the two sides of Freudian practice: the schemas
of “caring” and those of “curing.” The first make it possible to
focus clinical attention on the universality, typicalness, and unique-
ness of each patient. The second, enabling the identification of the
onset and genesis of disorders, provides dynamic starting points to
achieve improvements or even recoveries, in the psychic sense.
Discussion. – Defining a Freudian care/cure theory makes it possi-
ble to reopen the debate on different forms of therapy. A clinician
focusing on the brain or on symptoms alone may neglect the histor-
ical, social, and, above all, psychological contextuality (linked to the
individual’s life history) of so-called “mental” disorders. Focusing
on immediate individual experiences, the clinician may likewise
neglect the role played by the unconscious, as well as the typical
nature of the sufferings addressed – thus disqualifying her/his lis-
tening, despite the fact that listening is the foundation of cure/care.
Conclusions. – Given these two obstacles, Freudian psychoanalysis
provides a holistic and integrative approach. Focusing on the psy-
chodynamic dimension, it offers tailored, pragmatic, inventive, and
surprising treatments – the efficiency of which is today measurable
and also measured. Even if its concepts are part of the human (and
not experimental) sciences, this is why psychoanalysis remains an
attractive reference tool for clinicians in training and for a large part
of the most experienced practitioners.
© 2020 Elsevier Masson SAS. All rights reserved.
r é s u m é
Mots clés : Objectifs. – La « santé mentale » est aujourd’hui un enjeu crucial

Soin pour les sociétés. Mais le statut clinique des troubles visés fait
Psychodynamique débat, complexifiant l’appréciation des thérapies à recommander.
Métapsychologie Cet article prend part aux controverses actuelles. Son objectif est de
Typologie
dégager les opérateurs conceptuels d’une théorie psychanalytique
Étiologie
du soin, et de les situer par rapport à ceux d’autres approches – cen-
Thérapeutique
Transfert trées sur le cerveau, les symptômes, ou le vécu des personnes.
Neurosciences Méthode. – Dans une perspective épistémologique attentive aux
Symptômes pratiques cliniques et à partir d’une relecture des comptes rendus
Freud de cas de l’œuvre complète de Freud (1886–1939), il est proposé
une extraction des « schèmes opérateurs » de la psychanalyse freu-
dienne, entendue comme forme renouvelée de psychothérapie.
Résultats Ces « schèmes opérateurs » peuvent être distribués en
deux groupes, correspondant aux deux faces de la pratique freudi-
enne: les schèmes du « prendre soin » (care) et ceux des « actes de
soin » (cure). Les premiers rendent possibles une attention clinique
à l’universalité, à la typicité et à l’unicité de chaque patient. Les sec-
onds, permettant un repérage du déclenchement et de la genèse des
troubles, servent de points d’appui dynamiques pour conditionner
des améliorations, voire des rétablissements au sens psychique.
Discussion. – L’extraction d’une telle théorie du soin chez Freud
permet de relancer le débat sur les prises en charge. À focaliser
sur le cerveau ou les seuls symptômes, le clinicien ne néglige-t-il
pas la contextualité historique, sociale et surtout psychique (liée
à l’histoire de vie propre) des troubles dits « mentaux » ? Et à
focaliser sur les vécus individuels immédiats, le clinicien ne néglige-
t-il pas l’insu psychique tout autant que la typicité des souffrances
adressées – dé-qualifiant ainsi son écoute, pourtant au fondement
du soin ?
G. Visentini / L’évolution psychiatrique 85 (2020) e15–e32 e17
Conclusions. – Face à ces deux écueils, la psychanalyse freudienne

permet une approche holistique et intégrative. Se centrant sur
la dimension psychodynamique, elle propose des traitements sur
mesure, pragmatiques, inventifs, surprenants – dont l’efficience est
aujourd’hui mesurable et mesurée. C’est peut-être pourquoi, même
si ses concepts relèvent des sciences humaines (et non expéri-
mentales), la psychanalyse reste un référentiel attractif pour les
cliniciens en formation et pour une grande partie des praticiens les
plus expérimentés.
© 2020 Elsevier Masson SAS. Tous droits réservés.
1. Introduction
“Mental health” is a crucial issue in today’s societies. But the clinical status of the disorders under
consideration is up for debate, thereby complexifying the decision of which therapies to recommend.
Over the past 20 years, the neurosciences have inspired great expectations, both theoretically
and therapeutically. Neuroscience considers that “mental illnesses” are the consequence of patholo-
gies of the bios (genetic, neurodevelopmental, functional). The best treatments – evaluated through
randomized control trials – are those that focus on neuronal substrates (psychoactive drugs, neuroen-
hancement, psychosurgery).
For psychiatrists and psychologists who align themselves with “evidence-based” movements, the
most legitimate treatments are those therapeutic approaches whose efficacy has been demonstrated in
an experimental setting. A group of therapeutic protocols that target specific symptoms, specially con-
ceived to meet the conditions of the test environment, thus tend to be preferred (cognitive-behavioral
therapies, schemas, exposition through virtual reality, mentalization, acceptance and engagement,
mindfulness meditation, EMDR).
Over the past ten years, and in counterpoint to the abovementioned approaches, a new group
of mixed approaches has developed that is unafraid to call conventional treatment practices into
question in the name of personal experience and of users’ rights. These “new treatment models”
[1] critique the reductive definition of mental disorders by the mere presence of objectifiable and
quantifiable symptoms – thereby critiquing the most-used international diagnostic tools. These new
models bring the contextual and subjective dimensions of these disorders to the forefront and advocate
for therapeutic pragmatism. The lived knowledge of the concerned parties about the real effects of
different treatments on them thus has just as much value as scientific expertise, which is limited to
the potential statistical effects. One can cite, among these new “person-centered” theories, notions of
empowerment [2], of recovery [3], of care [4], of presence [5], of narrativity [6]. An “essential-values-
based practice” [7] attempts to integrate them theoretically.
Faced with the changes in the field of mental health in the 21st century, how is it that psychoanal-
ysis – whose clinical fundamentals date back to the last century – is still strongly supported in mental
health care institutions, taught at the university, and appreciated by young practitioners during their
studies? In a certain sense, there is something enigmatic at play. Is it nothing more than the vestiges of
psychoanalysis’s historical position of institutional dominance, as some suggest? In this sense, analyt-
ically oriented psychiatrists and psychologists would be abusing a clinical authority that has already
fallen from grace. But is psychoanalysis, in its historical and in its more recent forms, still able to offer
a theory of treatment that is not only ethically reasonable, but scientifically defendable, faced with
the “mental” suffering of contemporary women and men? And in this case, where can one situate its
epistemic level of effectiveness?
As Kuhn writes in The Structure of Scientific Revolutions:

Scientists have not generally needed [. . .] to be philosophers. To the extent that normal research
work can be conducted by using the paradigm as a model, rules and assumptions need not be
made explicit. [. . .] It is [. . .] particularly in periods of acknowledged crisis that scientists have

turned to philosophical analysis [. . .] ([8], pp. 131, 130).
Today’s analytically oriented practitioners are embroiled, in spite of themselves, in one such
“acknowledged crisis” of their theoretical frame of reference – whether they are psychiatrists, psy-
chologists, or psychoanalysts. Indeed, this reference is the object of frequent controversies. It seems
that now would be an appropriate time to propose an updated reflection on psychoanalysis’s “rules
and hypotheses” regarding its therapeutic application.
For those who consider psychoanalysis to be an old-fashioned theory, for those who would like it
to disappear from the field of mental health, or for those who long ago lost interest but integrate many
psychoanalytic ideas into their practice without always realizing or acknowledging it, I believe that it’s
important to succinctly reestablish what I consider to be the foundations of the theory of treatment
in psychoanalysis (at least in its Freudian version), thereby making them available for discussion and
critique. I will attempt to furnish a structured inventory of the clinical tools conceptualized by Freud.
In other words, I hope to epistemically elucidate what it means to fall ill, and to define diagnosis,
treatment, improvement, and recovery in a psychodynamic sense.
To begin, I will return to the fundamentals of the Freudian clinical practice. Next, I will present what
I consider to be the two major aspects of Freud’s theory of treatment, based on a reflexive reading of
his clinical writings (1886–1939).
2. The fundamentals of Freudian clinical practice
2.1. Psychoanalysis as a practice of treatment
For certain psychoanalysts today, the cure is essentially an experience of self-knowledge, of becom-
ing subjectively responsible, of confronting one’s lack of being or questioning one’s own desire. The
treatment of symptoms is a secondary concern. This essay is not the place to discuss this position. For
Freud, one point was always clear: above and beyond its other applications (ethico-existential, the-
oretical, speculative), psychoanalysis is above all a practice of clinical treatment, with a therapeutic
end:
As you know, psychoanalysis originated as a method of treatment; it has far outgrown this,
but it has not abandoned its home-ground and it is still linked to its contact with patients for
increasing its depth and for its further development. [. . .] The failures we meet with as therapists
are constantly setting us new tasks. ([9], p. 236)
For Freud, the practical and theoretical invention of psychoanalysis was, initially, a response to the
challenge of psychic suffering encountered in a medical setting, even if the response was a non-medical,
psychic one – that is, a form of therapy where “words are the essential tool of mental treatment” ([10],
p. 155): “Psycho-Analysis is a medical procedure which aims at the cure of certain forms of nervous
disease [. . .] by a psychological technique” ([11], p. 99).
Even if he considered the task of healing to be one of the three impossible professions, Freud judged
this new branch of psychotherapy as the most effective one among them: “psycho-analysis constitutes
the outcome and culmination of all the earlier methods of mental treatment” ([12], p. 236).
Where does this effectiveness come from? From the fact that, according to its inventor, rather than
working directly towards the healing of patients (with the illusions of omnipotence that this entails
and with the disillusions that it brings about), the psychoanalyst’s essential function is to foster the
conditions of the “work of giving help” ([13], p. 201) for the patients themselves:
[W]hen we take a neurotic patient into psycho-analytic treatment, [. . .] [w]e point out the
difficulties of the method to him, its long duration, the efforts and sacrifices it calls for; and as
regards its success, we tell him we cannot promise it with certainty, that it depends on his own
conduct, his understanding, his adaptability and his perseverance. ([14], p. 9)
In other words, whether s/he asks the patient to produce new syntheses (following analytic – that
is, de-synthetic – acts) or whether s/he supports and accompanies the patient’s existing syntheses
(using older techniques: suggestion, educative influence, advice about the patient’s bodily or social
life), the therapist-analyst leaves space for the patient’s own initiatives. It’s because of the fact that
that which makes a difference comes, ultimately, from the patient – in the form of a responsibility in
the activity of synthesis – that Freud qualifies healing as a “by-product” ([13], p. 201). This is not to
say that this healing is depreciated (as it has sometimes been interpreted). It’s that this healing comes
from the very person most concerned by it, the patient – which allows her/him to graduate from
the medicalized status of “patient” to become a veritable agent of her/his own treatment. For Freud,
psychoanalysis, from a treatment perspective, is a clinically conditioned autopsychotherapy.1
2.2. Psychoanalysis as a theory of treatment
For certain psychoanalysts today, analysis is a practice of contingency that cannot be formalized,
and that is organized only by the unexpected of the encounter. In order to be trained as a practi-
tioner, the only requirements are to have undertaken a personal analysis and to possess a sufficient
erudition – the latter perceived as an extraprofessional “general knowledge.” Rigor and a scientific
mindset would be, in this perspective, secondary. The present essay is not the place to discuss this
point of view. For Freud, one point was always perfectly clear: psychoanalysts must “make science”
out of their experience, organizing the cases they’ve treated in series, typologizing them based on
their clinical richness, and constantly revising the theoretical productions that arise from this. These
“duties [. . .] towards science” ([15], p. 188) are above all an ethical question. As soon as one claims
to heal, Freud remarks, one cannot work with inspiration alone. This would lead to a theory of treat-
ment that would be intuitive (implicit, undiscussed) and, therefore, partially insufficient and arbitrary.
Freud insists on the necessity of putting oneself in the shoes of one’s suffering patients. While they
are asking for help, they also require trust: “I think none of us would be so much as prepared to enter
a motor-car if its driver announced that he drove, unperturbed by traffic regulations, in accordance
with the impulses of his soaring imagination” ([9], p. 255).
Situating psychoanalysis – as a human science – in a “middle position between medicine and philos-
ophy” ([16], p. 130), the whole of Freud’s work demonstrates a formalization of a subtle and coherent
theory of psychodynamic treatment, even if the elements are somewhat disparate. Before examining
the particularities of these different tools (cf. parts 3 and 4), what are the general principles?
Let’s begin with a concrete situation. A patient comes to see the analyst. He explains the context
and the nature of his suffering. He asks for help. The analyst announces that she will be able to help the
patient solve his problems once their nature will have been more precisely determined. To this end, the
analyst suggests that the patient freely say everything that comes to mind regarding these problems.
Thus begins a series of exchanges where the analyst responds to the patient, takes an interest in what
he says, desires to know more, while the patient, through his words, unfurls the singular map of his
thoughts and of his inner life, that is, of his modes of psychic functioning.
How does the analyst transition from what could be nothing more than an open, friendly dialogue
(as today’s humanist psychotherapists conceive of their work) to a scientifically supported encounter?
By adding a (dissymmetrical) theoretical construction to the spontaneous construction of the experi-
ence. And by allowing herself the means of an epistemological break, in the sense that Bachelard gives
to the expression – even if this break must be partial, since the phenomena of the transference and
the countertransference (as we will see) pull towards a resymmetrization of the encounter and tend
to re-perpetuate it, or even to dis-orient it.
Nevertheless, it remains useful to methodologically distinguish between the phenomenological
level of the encounter (descriptive) and its scientific reconstruction (explicative and operational).
What does Freud propose here, in his dialogue with his fellow clinicians? Essentially, one could say
that he gifts them a theory of the psychic apparatus, as he presents it at the beginning of An Outline of
Psychoanalysis (1938), one of his final texts ([17], p. 231–236).
1
This is why the term “analysand” is often used today. The capacity for action of “patients” is, it seems to me, clearly
rediscovered by the new treatment models, even though these contain very few conceptual references to psychoanalysis.
If we reread it in light of contemporary practices, this psychic apparatus is the postulate of the
existence of a third context, the psychic, between the biological context (the reality of the body) and
the socio-historical context (the ambient cultural reality), for everyone – and thus for every suffering
patient. The noteworthy characteristics of this intermediary psychic reality are:
• to integrate the events that take place in the other realities of the body and of the social, translating
them into representations and affects;
• to be able to communicate with other psychic realities – including that of the therapist-analyst.
The psychic apparatus thus appears as the foundation of an autonomous experience of existence
(the Ego, in its interiority), linking and synthesizing the excitations that come from the bios (the Id,
as internal exteriority) as well as from social norms and values (the Superego, as external interiority)
in a singular, stratified experience – and one that exceeds the partial, “objective” description that
the biological or social sciences could make of it. The complexity of the intrapsychic has a history
(psychogenesis), over the course of which each interaction takes on meaning and is differentially
inscribed. Early events (whether traumatic or not) appear as the most significant, determining the
subject’s psychic “lifestyle.” Thus, all people have their own ways of experiencing the body, the other,
objects, the world.2
Freud takes as his starting postulate – which is still clinically borne out today – that so-called
“mental” disorders cannot be understood outside of the context of the (psychic) life stories of the
concerned parties. In consequence, his epistemic proposition is to give himself the means to objectify
the complex dimensions of patients’ intrapsychic worlds, so that a clinically appropriate treatment
can take place.
This is what distinguishes psychoanalysis from “therap[ies] of that kind” ([18], p. 49) that make
use of general suggestions, advice, rationalizations, or exercises. Freud calls these therapies empirical
“cosmetic[s]” ([14], p. 467), whose standard recipes are easy to learn, but which only treat – if there is
any treatment – the “typical” dimension of symptoms, and not their singular psychodynamic place in
the patient’s Ego. This question of epistemic functionality is also what differentiates psychoanalysis
from somatic therapies:
With our psychical therapy we attack at a different point in the combination — not exactly
at what we know are the roots of the phenomena, but nevertheless far enough away from
the symptoms, at a point which has been made accessible to us by some very remarkable
circumstances” ([14], p. 452)
That being said, the Freudian approach does not reduce “mental” disorders to their psychic
dimensions, those that are illuminated by the technique of free association. Recognizing that the
psychological is not ethereal, Freud’s theory leaves a place for the bodily dimension of pathogen-
esis (Freud himself preferred to leave the treatment of physical pathologies to other professionals’
expertise, while staying abreast of the latest advances in medicine):
It would [. . .] be a serious mistake to suppose that analysis favours or aims at a purely psycho-
logical view of mental disorders. It cannot overlook the fact that the other half of the problems
of psychiatry are concerned with the influence of organic factors (whether mechanical, toxic or
infective) on the mental apparatus. ([11], p. 109)
In the same way, his theory also integrates the external socio-historical dimension of pathogenesis
(by attempting to measure the internal influence – that of the Superego –, through a training in the
human sciences):
2
In this sense, one could say that, for the psychic apparatus, there is no “body” in a general sense, but instead, a unique
“psychobody,” just as – in the absence of a “sexuality” in the general sense –, there is only a singular “psychosexuality,” etc. An
a priori knowledge of a person’s psychic reality is impossible. One can only gather the elements of this psychic reality, case by
case, clinically, in the discursive dimension.
The details of the relation between the ego and the super-ego become completely intelligible
when they are traced back to the child’s attitude to its parents. This parental influence of course
includes in its operation not only the personalities of the actual parents but also the family, racial
and national traditions handed on through them, as well as the demands of the immediate social
milieu which they represent. In the same way, the super-ego, in the course of an individual’s
development, receives contributions from later successors and substitutes of his parents, such
as teachers and models in public life of admired social ideals. ([17], p. 235)
Even if its specificity lies in the fact that it focuses on the individual psychic dimension (a dimension
that is already rich in echoes of the body and the socius), Freud’s psychoanalysis also makes use of a
clinical attention to the external world that calls to mind the “biopsychosocial” approach, to use today’s
terminology.
2.3. Psychoanalysis as an act of caring for the other
In order to more precisely define the psychoanalytic approach to treatment – and always in dialogue
with the contemporary –, it can be useful to refer to the conceptual distinction that is made today in
philosophy between “curing someone” and “taking care of someone” or “caring for someone.” In “The
Two Concepts of Care: Life, Medicine, and Moral Relations” (2006), Frédéric Worms presents it in this
way:
Caring is caring for something (an identifiable and treatable need or suffering), but it is also caring
for someone. Thus, all care necessarily implies a degree of intention and relation, however small.
[. . .] Thus, although there are two concepts of care, they are inherently linked. [. . .] They are
two conceptions of the same relationship. ([19], p. 143)
Worms adds that “the opposite of care [is], in philosophical, medical, and life terms, [. . .] negligence
or neglect.” Healing, from an ethical and therapeutic point of view, means not neglecting the treatment
of symptoms, but also not losing sight of the person affected by a symptom. But the philosopher
observes that, with the growing power of experimental medicine, the doctor/patient relationship has
been almost exclusively centered on cure (with knowledge gained in the laboratory purported to
be effective for all symptoms), to the detriment of care (the effectiveness of a clinical gesture that
takes the patient’s needs into account). With growing technical automation, the therapeutic act has
become hyperspecialized and strictly functional – whether in somatic medicine, in psychiatry, or in
psychology –, leading to these professions’ recent “rediscovery” of the clinical effectiveness of listening,
of empathy, and of taking the other’s point of view into consideration.
In this controversial context, the analytic approach can lay claim to a renewed legitimacy. If Freud
speaks of the “analytic cure,” he suggests, indeed, that no treatment can take place without concerning
oneself with the life of the (suffering) mind, understood as a dynamic whole. In this, he differentiates
himself from the first experimental approaches of the early 20th century, which dissociated individuals
from their symptoms – the latter of which were reduced to statistically measurable items. Fundamen-
tally, for Freud, the cure happens through taking care of patients, of their history, and of their ways
of experiencing their relationship to the body, to others, and to the world. Only a “clinical human sci-
ences” approach can, from this point of view, take into consideration the imbrications of this double
dimension of the therapeutic relationship – a relationship thus de-centered from symptomatic traits.
Among the “human” tools available to the therapist-analyst, I propose to differentiate between
those related to care and those related to cure. Methodologically, I will call these practical “operational
schemas” (taking up Kant’s term of “schema”3 ), in order to insist upon the fact that these are epistemic
tools, borne out of a professional4 training that gives the analytic encounter its asymmetrical form and
its characteristic edge, beyond a spontaneous care/cure. These schemas, insofar as they allow for a
3
For Kant, this term designates “intermediate representations” that allow for acts of judgment of empirical intuitions, based
on categories of pure reason. These representations are at once homogenous to concepts and to phenomena, ([20], p. 188).
4
I use the concept of “professionalization” in its acceptation in the sociology “of professions,” in order to designate the group
dynamic through which psychoanalysts – even if they don’t always think of it in this way – socially define the sense of their
transposition and a reconstruction of that which takes place in the encounter (with a view to its
technical deployment), constitute the “[human] scientific self”5 of psychoanalysts.
3. Schemas of psychoanalytic caring
Unlike the schemas of “acts of cure” (cf. Section 4), which create the effective conditions of thera-
peutic work, the schemas of care establish the horizon of the work. These are the schemas of a clinical
reception. They allow the therapist-analyst to take care of their patients’ universality (metapsycho-
logical schemas), their typicalness (semio-typological schemas), and their uniqueness (schemas of
“attentional decentering”).
3.1. Universal operational schemas
These metapsychologically6 postulate, for every patient, the existence of a psychic apparatus under-
stood as the autonomous space of a distinct affective-representational life, with the capacity, even if
minimal, to communicate with others, and which can be described according to its dynamic, topi-
cal, and economic dimensions. These schemas allow us to transcribe the interactions of the clinical
situation and to distinguish, in the patients’ speech, between:
• dynamic conflicts (between more or less contradictory speech acts);

• topical contrasts (between more or less discursively structured speech acts);
• economic variations (between speech acts that are more or less affectively invested).
From here, different modes of functioning can be observed within different psychic apparatuses,
for example, in the relationships between the Ego, the Id, and the Superego – whether these are
constitutive (introjections, links, displacements, condensations), defensive (repression, negation, isola-
tion, intellectualization, banalization, conflict avoidance, splitting, denial, rejection, projection, etc.),
or relational (transferences, countertransferences).
These metapsychological schemas are one of the originalities of Freud’s theory. They proclaim
that one can take care of a distinct psychic life, alongside biological and social life. Their use allows
practitioners to enact the universality of the clinical reception. There can be no differentiation on this
level, even for those psychic apparatuses that are most strongly identified with the non-human (the
animal or the vegetal)7 and communicate, therefore, without verbalization.
It’s the strictly formal nature of these metapsychological schemas that allows for the unconditional
universality of the psychoanalytic encounter. These schemas imply that there are psychodynamic
processes at work with every patient, no matter the effective content.
3.2. Typical operational schemas
These represent the empirical gains of the practice of psychoanalysis. Certain psychic apparatuses
can be organized into series, based on certain objectifiable significant traits: types of transference, of
fantasmatic scenarios, of identifications, of internal stratifications and divisions of the psychic appa-
ratus; and (as far as lived experiences can be objectifiable) of types of anxieties, of problematics, and
of demands.
From this can emerge – to take just one typological example (and the most central, clinically speak-
ing) – an overview of types of psychic organization, from the particular to the general. Freud, in this
sense, distinguishes between singular psychic lives for which, when things are going poorly – that
mission and the nature of their conceptual tools (thus the foundation of the training that they provide), in a relatively autonomous
manner. Cf. Everett Hughes, Andre Abbott, Eliot Freidson.
5
Taking up Daston and Galison’s expression ([21], p. 50).
6
For Freud, beyond the (pre-scientific) categories used by spontaneous psychology.
7
Cf. Harold Searles’ work on the non-human [22].
is, in the case of a “a failure in the [synthetic] functioning of the ego” ([23], p. 6) – problems can be
defined as:
• neurotic (intrapsychic conflict – experienced as guilt-inducing, paralyzing, the source of complaints);

• narcissistic (fragility of internal links – experienced as lacerating, splitting, depressing, prejudicial);
• perverse (an excess of autoerotic instinctual fixations – experienced as incessant, alienating, socially
isolating, harassing);
• psychotic (fragility of the psychic apparatus itself – leading to experiences of stupefaction, melan-
choly, fragmentation, persecution; and experienced as desocializing and handicapping).
We can call these schemas “semio-typological,” as they allow us to move our attention, clinically,
from empirical signifiers to organized types. Adding these schemas to the first order of schemas allows
for a complexification and declension of the latter. They allow us to care for each patient in a specific
way.
Thus, when meeting a patient with limited capacities for analyzing her/himself or others, the
attentive Freudian analyst will avoid making the patient ill at ease with interpretations that focus
on intrapsychic processes. S/he will welcome a patient weighed down by adhesion to an autoerotic
instinctual object without defensive countertransferential reactions. S/he will care for a patient whose
psychic life is deficient by being more present and more supportive in the therapeutic relationship,
in order to facilitate a progressive process of de-splitting and of linking internal representations and
affects. And s/he will take care, in the relationship with a patient whose intrapsychic space is mired
in complexes and marked by an instinctual overinvestment of childhood representations, to propose
analytic (that is, de-synthesizing) interpretations, in order to help the patient open up new spaces of
psychic self-reflection.
For an analyst to enter into therapeutic relationships without differentiating between patients’
psychic organizations, their problems, and their modes of functioning would be, for Freud, a form of
negligence of these people in their specificity. “Undifferentiated” approaches – which don’t require
therapists to be trained in this clinical typologization – can generate psychic mistreatment, such as
declaring that delusion is a form of “cognitive bias,”8 or passing a moral judgment on instinctual
fixations, or encouraging intrapsychically fragile patients to think positive and get ahold of themselves,
because “everyone can do it.”9
Another pitfall, this one for psychoanalysts, consists in confusing these schemas with those of the
first group. This leads them to transform typical empirical observations (applicable to certain series of
cases) into universal formal acquisitions (applicable to all cases). In this, they neglect the psycho-socio-
historical characteristics of their clinical practice and uncritically propagate notions of normativity
that can potentially do violence to their patients. For example, there are certain analysts – men and
women – who systematically and a priori discern penis envy in every woman. These analysts make use
of typologizations with every woman patient that are, in reality, only applicable to some women. The
same type of clinical paralogism is present when the Oedipus complex is said to structure the fantasies
of each and every psychic apparatus. In this case, something that was a clinical breakthrough in the
understanding of the series of “neurotic” patients (women and men alike) is used, among others, to
misrecognize the series of “psychotic” patients – for whom an overinvestment of childhood sexuality
is not the central problem (rather, this would be enigmatic experiences of dissolving).
3.3. Unique operational schemas
These represent that which is the most originally psychoanalytic in the Freudian approach to care.
Indeed, the first two groups of schemas (even if they were entirely re-thought with the needs of a
8
Here I am reminded of a psychiatrist trained in cognitive-behavioral theories who, visiting an hospitalized patient, gave her
this sort of cognitive “lesson.”
9
Here I am reminded of a patient who, after receiving this kind of pep talk from a well-intentioned hypnotherapist, made a
serious suicide attempt that could have ended her life.
psychodynamic clinical practice in mind) are taken from the natural sciences (the metapsychological
schemas) and, for the semio-typological schemas, borrowed from medicine – as has been abundantly
documented.10
I propose the name of “attentional decentering” for this third group of “hollowed-out” schemas,
meant to receive an as-yet-unconstituted knowledge, even if this knowledge is actively anticipated.
Through a form of unlearning of the patient’s accumulated experiences, they make it possible for
her/him to be receptive to the contingencies through which the singularity of the psychic apparatus
always make itself known – sooner or later. These schemas are like captors of discrete events, through
which the absolute differences between patients are delineated, in the sense of the dynamics of the
patient’s own psychic life.
By way of an example, take the schema of “attention to incoherent details.” According to Freud,
truly analytic work takes place when the analyst notices what he calls “the dregs, one might say, of the
world of phenomena” ([14], p. 20). It’s through these small, isolated details that are out of sync with
the clinical tableau (conceived of according to the two other groups), that the psychic apparatus, the
only one of its kind, makes itself known: “[T]he technique of psycho-analysis [. . .] too, is accustomed
to divine secret and concealed things from despised or unnoticed features, from the rubbish-heap, as
it were, of our observations” ([29], p. 143).
One remarkable characteristic of these unique operational schemas is that some of them are pro-
gressively shared by the analyst and the patient, each at her/his respective place.
Take, for example, the schema of “evenly-suspended listening,” one of the best known. The aim, for
the analyst, is to avoid immediately judging, selecting, or prioritizing any of the ensemble of clinical
signifiers that are presented to him in his position of knowledge, and this in order to offer the analysand
the space where her unique traits can be deployed through free association. As Freud explains: “It is
not in the least our business to ‘understand’ a case at once: this is only possible at a later stage, when
we have received enough impressions of it. For the present we will suspend our judgment and give
our impartial attention to everything that there is to observe” ([30], p. 19).
But, fundamentally, the analysand also learns to handle this schema, through the analyst’s pre-
venting his attempts to “understand himself” right away, or to rationalize his problems, or to theorize
his life according to what is “typical.” The analysand, too, must de-center himself from his position
of conscious mastery (the syntheses of the Ego), in order to give free rein to the associations that
reveal – within the analytic situation – his unconscious psychic life, in the nuances of its uniqueness.
This helps explain why the schema of “free association” is, in some ways, the flip side of evenly-
suspended attention. For the analysand, free association is an invitation to say everything that comes
to mind, without judging, establishing a hierarchy, or selecting from her incidental thoughts; that is,
free association invites the analysand to be attentive to her own uniqueness. This schema also allows
the analyst to give himself over to his personal associations, in a reciprocal motion of opening to his
own psychic singularity. Notice that these operational schemas of uniqueness are opposed to those of
the first two groups. The third-group schemas complicate the use of the others, and limit the ways in
which they can be used, opening up a space and a time for patients to speak their singularity.
In epistemically organizing a position of unknowing (dis-attention to the universal and to the
typical), the operational schemas of uniqueness give analytic listening its unique and surprising qual-
ity, its sensitivity to contexts, to occasions, and to the multiple events of the analytic session. These
schemas complexify psychoanalytic care by superimposing a third, paradoxical layer to the first two
layers, allowing the analyst to discover “the rest of the case history” ([31], p. 164) as being unlike
any other. In this sense, and as it’s often been pointed out, they are not connected to a theoretical
training (as is the case with the metapsychological schemas), nor even to a simply clinical train-
ing (the semio-typological schemas), but require a specifically analytic training, of which the basis
remains one’s personal analysis. It’s because one has been attentive to the absolute difference of
10
On Freud’s “naturalist” heritage, I refer the reader to the pioneering work of Paul-Laurent Assoun [24], as well as to the more
recent study by Frédéric Forest [25]. Regarding Freudian concepts’ roots in the medical “episteme,” the work of Paul Bercherie,
following upon that of Georges Lanteri-Laura, offers a solid base [26]. And on Freud’s neurological and psychiatric heritage,
from a nosographical point of view, recent research by Thomas Lepoutre and François Villa is perfectly illuminating [27,28].
her/his own psychic processes – through decentering oneself from one’s self-typologizations and self-
universalizations – that one can be actively receptive, beyond one’s theoretical and clinical capacities,
to the uniqueness of the suffering individual’s psychic life. In fact, since these schemas are progres-
sively integrated by analysands over the course of the cure (as a secondary acquisition), a certain
number of them go on to become psychoanalysts themselves.
Finally, these schemas are therapeutically essential. For, unlike clinical work, which requires that
the three levels be treated, from a psychoanalytic point of view, effective therapeutic work is neither
universal (as the neurosciences consider it to be), nor even typical (as it is considered by thera-
pies that focus on types of symptoms). Psychoanalytic therapy takes place in the dimension of the
unique. It takes place, case by case and person by person, in the enunciative dynamics of the analytic
session – thus rendering these unique operational schemas essential over the course of the cure.
4. Schemas of psychoanalytic curing
Through which means does the therapist-analyst perform acts of treatment, properly speaking? In
his clinical texts, Freud allows us to differentiate between two groups of operational schemas at play
in the cure:
• etiological schemas, which allow the analyst to determine, for each case, the precise coordinates of
the patient’s falling ill;
• therapeutic schemas, which allow the analyst to enact, for each case, the precise conditions of
improvement and recovery.
This allows the patient to bear, psychodynamically speaking, the operative dimension of psycho-
analysis: “For a psychoanalysis is not an impartial scientific investigation, but a therapeutic measure.
Its essence is not to prove anything, but merely to alter something” ([30], p. 92).
4.1. Etiological schemas
Freud’s debt to medicine is evident in his elaboration of the etiological schemas. By the turn of the
20th century, it was scientifically accepted that there is less linear causality in living beings than there
is in the physico-chemical world. The presence of the smallpox virus is necessary, but not sufficient,
for a person to contract the disease. And this because the organism possesses, to a certain extent,
a power of action. It can contain the effects of the virus, or even eliminate it. Freud takes up this
dynamic conception in order to think through the “threshold-values” ([32], p. 169) of the normal and
the pathological in the psychic apparatus:
For illnesses — those, at least, which are rightly named “functional” — do not presuppose [. . .]
the production of fresh splits in its interior. They are to be explained on a dynamic basis — by
the strengthening and weakening of the various components in the interplay of forces, so many
of whose effects are hidden from view while functions are normal. ([33], p. 664)
The different types of psychic organization thus established, one must determine, on a case-by-
case basis, and within each type, the movement from “doing well” (the normal) to “doing poorly” (the
pathological). For this, one must evaluate the weight of the different factors in play. This is easier
after the fact, after a disorder has appeared. Freud responds to the question of knowing where the
pathogenetic process appears thanks to a “complete [. . .] aetiological survey” ([34], p. 69). As early as
1895, he constructs an “aetiological equation of several terms:”
I think we can arrive at a picture of the probably very complicated aetiological situation which
prevails in the pathology of the neuroses if we postulate the following concepts: (a) Precondition,
(b) Specific Cause, (c) Concurrent Causes, and, as a term which is not equivalent to the foregoing
ones, (d) Precipitating or Releasing Cause. ([35], p. 74)
The “preconditions” refer to the constitutional aspect (today we would say the genetic or the neu-
rodevelopmental aspect) of the psychodynamic forces in play. These must never be neglected: either
they diminish, relatively speaking, the Ego’s capacities for synthesis (through a somatic deficiency
that affects the psychic apparatus11 ) or they determine the intensity of a particular force (a strong
instinctual drive, for example, that the Ego must use in the work of building links).
The specific causes are those that define the ways in which power dynamics are structured (psychic
conflictuality in the case of neurotic disorders, undoing of investments and compensatory neo-Ego in
the case of psychotic disorders, etc.). These structural types define the types of potential disorders and
thus the patient’s falling ill. As Freud puts it, a crystal that is thrown to the ground “breaks; but not into
haphazard pieces. It comes apart along its lines of cleavage into fragments whose boundaries, though
they were invisible, were predetermined by the crystal’s structure” ([9], p. 142). The semio-typological
types support the etiological schemas.
The concurrent causes are all of the factors that might modify psychodynamic power dynamics.
Freud’s clinical case studies demonstrate their variety: the birth of a sibling, puberty, sexual temp-
tation, a romantic encounter, orgasm, arguments, marriage, the family environment, sexual activity,
beginning one’s professional career, fatigue, overwork, a promotion, social pressure, personal failures,
a change in one’s situation, words addressed to the patient, forbidden thoughts, grief, menopause,
a psychic rigidification, illnesses, a negative transference, etc. Ultimately, Freud groups these factors
under the banner of “frustration” ([36], p. 119), in the sense that they frustrate the psychic apparatus
in its attempts to maintain the status quo (disturbing its internal equilibrium) and thus force it to work
to re-synthesize in order to preserve its functional stability.
The precipitating cause is, finally, a simple concurrent cause, but one that acquires a clinically
decisive value for the psychic apparatus: the precipitating cause releases a rupture of the psychic
apparatus’s equilibrium, leading to a pathogenic state. It’s through the type of disequilibrium produced
that indications are given, a posteriori, regarding the type of organization. The loss of a loved one does
not have the same consequences for different people, because of the different psychic statuses that
the object can have. In neurotic organizations, it stands in for the “lost” object, one in a series, and
because of this can, after a period of mourning, be replaced by another. In psychotic organizations,
the object is psychically identified with the Ego and serves as a kind of existential anaclisis: the loss of
the object is equivalent to the loss of a part of the Ego: “In some people the same influences produce
melancholia instead of mourning and we consequently suspect them of a pathological disposition”
([37], p. 264).
As one can see, the psychodynamic model of psychoanalysis is extremely complex. Freud made it
even more complicated over time, by adjusting it to coincide with what he learned through his clinical
practice12 .
Despite a certain amount of internal fragility, the psychic apparatus has its own resources, as well.
Thus Freud points out that “not every disposition is necessarily developed into a disorder” ([39], p.
123). Psychodynamic compensations are always at work before a precipitating cause, in some cases,
arrives and causes them to fail: “in the clinical picture of the psychosis [but the same could be said for
all types of psychic organization], the manifestations of the pathogenic process are often overlaid by
manifestations of an attempt at a cure or a reconstruction” ([23], p. 5).
The Ego can always count on its capacities of synthesis, which vary from person to person. An
individual’s life story, both past (psychogenesis) and present (her/his current life conditions), fully
participates in the “dynamics of the construction of symptoms” ([14], p. 292), which is, thus, insep-
arable from the person’s overall psychic life – contrary to the suppositions underpinning certain
protocol-based therapies that focus exclusively on symptoms. For Freud, an overall evaluation of the
11
In autism, for example, but also, perhaps, for some forms of schizophrenia.
12
Over time, Freud used the “complementary series” schema (initially conceived of to think through the multiplicity of
etiological factors) to re-elaborate two etiological factors (the constitutional and the adjuvant). He stopped considering these
factors as series with a kind of one-way gradation (from the more to the less), and instead began envisaging them as factors
with a double gradation (with two poles). This allowed him to distinguish, in the constitutional (non-modifiable), between the
hereditary and the psychically acquired (instinctual or superegotic fixations, which also determine a non-modifiable: the types
of psychic organization) ([38], p. 178).
psychodynamic context can give indications, both about the onset and the development of disorders
and about the possible pathways to recovery: “the attempt at discovering the determining cause of a
symptom was at the same time a therapeutic manœuvre” ([40], p. 343).
The coordinates of the pathological breakdown give, in effect, precise indications about the char-
acteristic points of fragility of a given psychic apparatus, and, through this, about the type and the
uniqueness of the acts of healing that the therapist-analyst can dispense – acts that, Freud insists,
should operate in a “place in an assignable mental context” ([14], p. 453).
4.2. Therapeutic schemas
I hope that it is more clear now that the Freudian conception of “doing poorly” rests on the idea
of an internal imbalance in the psychodynamic power relationship. Being “sick” is thus in no way
substantial, nor can a subject be definitively “healed:” “the patient’s illness [. . .] is not something
which has been rounded off and become rigid but that it is still growing and developing like a living
organism” ([14], p. 458).
In this sense, strictly speaking (and even if Freud continues to speak of “illness” – just as he continues
to speak of his “patients”), psychodynamic disorders should be differentiated from “mental illnesses,”
in the sense that biological psychiatry gives to this term. According to the Freudian etiological equation,
it’s only when the “constitutional” factor outweighs all the others (that is, the three psychic factors)
that the illness “is not psychogenic but somatogenic — that its causes are not mental but physical”
([34], p. 68). In those cases where the factors are, above all, psychic (relating to specific, concurrent,
and precipitating causes), psychotherapy is the legitimate treatment – and psychoanalysis is the most
clinically advanced version (according to Freud). The goal is to create the conditions that will lead to
modifications in the internal power relationships of a given psychic apparatus, and thus encourage it
to leave the pathological state (recovery). Here, we can extract and focus on two subgroups of schemas
in the Freudian practice: “handling of quantity” and “handling of the transference.”
4.2.1. Schemas of the handling of quantity

The principal therapeutic schemas in Freud’s pragmatic clinical practice are those of the “handling of
quantity,” supported by the metapsychological schemas (notably the “economic” ones). In effect, Freud
points out that the pathological always stems from an economic modification of power dynamics: “the
decision on whether the outcome is to be illness or not always lies with quantitative factors” ([14], p.
417).
Over time, Freud accorded the economic dimension a crucial importance, culminating in his intu-
ition that the play of quantities is the central resource of the psychodynamic cure:
I have introduced a fresh factor into the structure of the aetiological chain — namely the quan-
tity, the magnitude, of the energies concerned. We have still to take this factor into account
everywhere. [. . .] We must tell ourselves that the conflict between two trends does not break
out till certain intensities of cathexis have been reached, even though the determinants for it
have long been present so far as their subject-matter is concerned. ([14], p. 387)
If the economic aspect causes the Ego to fall psychically ill, Freud concludes that “doing better”
occurs through (inverse) interior economic re-modifications of each type of Ego: “what happened to
these [. . .] displaceable magnitudes, that was the decisive factor both for the onset of illness and for
recovery” ([41], p. 14).
Psychoanalysis is confronted with this difficulty – inseparable from the richness of its acts of heal-
ing: the accumulation of the quantifiable is pathogenic, while the discrete units of quantity come from
the different psychic instances (the Ego, the Id, the Superego) and are only open to handling in the
context of the different types of ego-organizations in which they take root, as well as in the context
of the uniqueness of the Ego(s). Psychic life is not a simple abstract arithmetics; it cannot be “solved”
by an operational general calculus. The therapist-analyst can play with the power dynamics, but must
take into account the different contextual factors – which requires tact and discernment.
If the technique is difficult to manage, it’s because the modification of each term of a power dynamic
influences the overall accumulation. In effect, Freud remarks that psychic quantity is a relative concept
and, as such, a dynamic one: “a relative increase in the quantity of libido may have the same effects as
an absolute one” ([36], p. 125).
Psychic life is so complex that a weakening of the Ego – even one due to external causes (fatigue,
stress) – modifies the power dynamics and relatively increases internal quantities (of investment, for
example), without, however, causing an absolute increase:
A person only falls ill of a neurosis if his ego has lost the capacity to allocate his libido in some
way. The stronger is his ego, the easier will it be for it to carry out that task. Any weakening of
his ego from whatever cause must have the same effect as an excessive increase in the claims
of the libido and will thus make it possible for him to fall ill of a neurosis. ([14], p. 400)
Taking this complexity into account makes the ensemble of parameters of a person’s life – psychic,
biological, social – potentially decisive from a therapeutic point of view. A supportive family environ-
ment strengthens the Ego; but familial investment of ideals or values can, on the contrary, slow down
the recovery process: “the prospects of a treatment are determined by the patient’s social milieu and
the cultural level of his family” ([14], p. 478).
Following this psychodynamic logic, the irruption of a somatic illness can, likewise, bring about
a psychic disorder, just as, inversely, it can make a psychic disturbance disappear via an internal
rebalancing of quantities:
It is also well known, though the libido theory has not yet made sufficient use of the fact, that
such severe disorders in the distribution of libido as melancholia are temporarily brought to an
end by intercurrent organic illness, and indeed that even a fully developed condition of dementia
praecox is capable of a temporary remission in these same circumstances. ([42], p. 305)
This is also why life events have a therapeutic value, to which Freud gives the name of the cure by
fate ([36], p. 119):
It is instructive, too, to find, contrary to all theory and expectation, that a neurosis which has
defied every therapeutic effort may vanish if the subject becomes involved in the misery of
an unhappy marriage, or loses all his money, or develops a dangerous organic disease. In such
instances one form of suffering has been replaced by another; and we see that all that mattered
was that it should be possible to maintain a certain amount of suffering. ([43], p. 18)
Freud also notes that, sometimes, these self-healings stem not from chance, but from the Ego’s
unconscious choices: “Nor is it hard to discern that all the ties that bind people to mystico-religious or
philosophico-religious sects and communities are expressions of crooked cures of all kinds of neuroses
[but the same could be said for all types of psychic organization]” ([44], p. 81).
If these psychic quantities are the principal tool of the cure, how can they best be handled? Freud
progressively discovered that the therapeutic relationship itself exercises a determining influence
on these quantities: since they are intra-psychically relative, they are particularly receptive to being
brought into inter-psychic relationships.
4.2.2. Schemas of the handling of the transference

When the Ego heals itself, there’s no need for a therapeutic relationship to help reestablish an
internal balance. The Ego responds to occasional imbalances with self-induced restabilizing (bringing
an ensemble of intra-psychic “relationships” into play). But when these internal relationships are
strained (a burst of superego anxiety in neurosis, emptiness and depression in narcissistic structures,
stupefying phenomena in psychosis), the desire for an inter-psychic relationship may be expressed:
Slight disorders may perhaps be brought to an end by the subject’s unaided efforts, but never
a neurosis — a thing which has set itself up against the ego as an element alien to it. To get the
better of such an element another person must be brought in, and in so far as that other person
can be of assistance the neurosis will be curable. ([30], p. 92)
How can the therapeutic other influence the internal power dynamics of a psychically suffering
person? Here, Freud’s theorization is strikingly original, based on clinical observations that precede
him and that outlive him, regarding the therapeutic effectiveness of the relationship. Since it’s in the
“individual’s mental life [that] someone else is invariably involved, as a model, as an object, as a helper,
as an opponent,” and because “from the very first individual psychology, in this extended but entirely
justifiable sense of the words, is at the same time social psychology as well” ([44], p. 5), the therapist-
analyst will be able to, from within the “inter” relationship, hew closely to the patient’s “intra” psychic
life. This intimate linking of psychic apparatuses is, today, viewed with skepticism by a technicist ideal
of care. But one can’t deny that the analytic approach allows for a veritable encounter between two
psychic lives. An encounter that modifies – reciprocally, if dissymetrically – the power dynamics of
both of them. An encounter that allows for a “care-cure,” to use the post-Freudian phrase of Winnicott
([45], p. 168).
Freud theorizes the modification of quantifiable intra-psychic relationships (the patient’s) via the
inter-psychic with the help of the operational schema of the handling of the transference – and its dou-
ble, the schema of the handling of the counter-transference. The transference being a “a phenomenon
which is intimately bound up with the nature of the illness itself” ([14], p. 458), the recognition and the
handling of this phenomenon (which transcends, in part, the distinction between healer and healed)
is, for Freud, “our most powerful dynamic weapon” ([34], p. 50).
Thanks to the transference, the therapist-analyst “work[s] with the help of ‘suggestion’ ([14], p.
463), even if, as Freud quickly learned himself, “suggestion does not exercise unlimited power but
only power of a definite strength” ([10], p. 174). In certain clinical situations, one aims to work on
the transference, aiming for a dis-investment or a liquidation of it; this is the case when the quanta
of excitation invested by the Ego in the therapist-analyst are “libidinal” in nature (that is, rooted in
childhood sexuality) and when the therapist-analyst becomes the psychic stand-in for one or more
unconscious representations of other-helpers (parents or other close relationships). In other cases,
one is resigned to working with the transference, without inciting the Ego to reflect upon it in its intra-
psychic depths, using the transference as a simple psychodynamic tool. In all cases, the clinician works
step by step, respecting the patient’s internal resistances and placing her/his bets on a “cumulation of
partial therapeutic effects” ([46], p. 312).
Freud gives a very precise definition of the stakes of what can be achieved through this type of
work:
Just as health and sickness are not different from each other in essence but are only separated
by a quantitative line of demarcation which can be determined in practice, so the aim of the
treatment will never be anything else but the practical recovery of the patient, the restoration
of his ability to lead an active life and of his capacity for enjoyment. In a treatment which
is incomplete or in which success is not perfect, one may at any rate achieve a considerable
improvement in the general mental condition, while the symptoms (though now of smaller
importance to the patient) may continue to exist without stamping him as a sick man. ([47], p.
15).
Recovery is thus a form of crossing a threshold in each individual’s psychic “doing better.” From a
psychodynamic point of view, an accumulation of improvements can lead to this place, even if certain
symptoms never truly disappear: “Our aim will not be to rub off every peculiarity of human character
for the sake of a schematic ‘normality’, nor yet to demand that the person who has been ‘thoroughly
analysed’ shall feel no passions and develop no internal conflicts” ([48], p. 52).
In other words, one can return to a normal life (in the sense of each subject’s internal norm), without
having achieved the “external” ideal of a normal life (in the descriptive sense of scientific studies, of
public health policies, or even of what is socially predominant).13 In this, psychoanalysis is clearly in
opposition to heteronormative approaches that focus on symptoms to the exclusion of all else; and
13
In this sense, we can speak of a “psychic normativity” in Freud’s writings, in reference to Canguilhem’s conception of
“biological normativity” ([49], pp. 76–91).
psychoanalysis takes its place – as a pioneering discipline – alongside the “new models of care” evoked
in the introduction.
5. Conclusion
To resume, Freud’s conception of the psychoanalytic cure – in a certain sense (and a sense that is
only rarely presented) – is that of a pragmatic of psychic quanta, individually tailored to the patient
(typicalness, uniqueness), and in the transference. After having discerned the coordinates of the onset
and the genesis of the disorder, it’s up to the therapist-analyst to create the conditions that will allow
for an improvement in the patient’s psychic suffering (or even a recovery), within the confines of an
effective verbal relationship.
To this end, a panel of operational schemas is available: schemas of reception and of clinical atten-
tion, and others that are more pointedly curative. Among the latter, some lead to an ana-lysis; others
foster syn-theses. The principal characteristic of Freudian psychoanalysis, from this point of view,
is thus not analytic, but, more fundamentally, psychodynamic – even if the term invented by Freud
accentuates the innovative aspect of his method (its analyticalness). From a clinical point of view,
it’s the perpetual back-and-forth between analytic and synthetic operations that – in virtue of their
psychodynamic “accumulation” – counts.
For Freud the therapist, the specifically analytic tools are only recommended – that is, effective – in
cases of neurotic suffering and for certain cases of narcissistic suffering ([14], p. 451). For other types of
suffering (psychotic or perverse, for example), synthetic tools are the most useful, and might be used
exclusively – while still allowing for, however, the use of the ensemble of psychoanalysis’s schemas of
care (the reception of the universal, of typicalness, and, especially, of the psychic uniqueness of each
patient).
The singularity of Freud’s psychoanalytic – psychodynamic – approach, in the end, is found in
the fact that it’s up to the patient to do the work of rebalancing her/his intrapsychic forces. The
therapist-analyst creates the conditions for this work, accompanies it, and encourages it, but the
effective operation is at the initiative of the patient’s psychic apparatus. For a series of cases, this type
of work can lead to “a permanent alteration in his mental economy” ([50], p. 89). In other cases, the
recuperation of the patient’s capacities to act and to take pleasure in what s/he does remains fragile
and dependent on outside conditions – to such an extent that one can’t be certain of the “means of
predicting what the later history of the recovery will be” ([48], p. 24). Finally, in still other cases, this
approach involving the implication of psychic life (in a close relationship) is inappropriate – making
other forms of therapy a practical necessity.
However, whatever one’s opinion of it, no other competing approach – whether it involves putting
the brain, the symptoms, or the experiences of patients at the center – can offer the socius a more
effective treatment for all types of patients – and, even less, a perfect effectiveness for each one of them,
taken one by one. This dream continues to evade us. Thus, what we call “mental health” remains a field
where a multiplicity of studies and experiments continue to be performed. It’s up to each clinician to
choose the therapeutic approach whose ethic and responsibility s/he feels most capable to carry out.
And it’s up to each subject to choose the approach that s/he thinks could be the most helpful – since
any given therapy’s effectiveness can only be measured, in fine, by those most directly concerned.14
All of these considerations lead us, ultimately, to reframe the question of psychoanalysis’s “self-
consciousness.” Even today, this remains (in discourse) massively analytico-centered, even though, in
reality, the practice has been greatly diversified. If, indeed, psychoanalysis was originally developed
with neurotic adult patients (in the setting of the typical cure), the practice was extended – through
the universality of its schemas of reception – to patients of diverse ages and psychic modes of func-
tioning. Yet the theoretical definition of psychoanalysis – especially in the francophone world – has
not adjusted itself to the contemporary reality of the practice. In its fidelity to the first, “Oedipal”
14
Statistical studies on the comparative effectiveness of different psychotherapies, when they are correctly interpreted,
demonstrate interesting empirical indications. Their numerous epistemic, methodological, and, therefore, clinical limitations
make it impossible to weigh in unilaterally in this debate.
cases (hysterical and obsessional patients), psychoanalysis has tended, implicitly, to consider other
types of suffering people as “difficult cases” – and, sometimes, the work undertaken with them as
non-psychoanalytic. Which leads us to a confrontation with this alternative: either psychoanalysis is
a theory of care through pure analysis, reserved for neurotic patients, and its (idealized) definition is
acceptable; or psychoanalysis should liberate itself from the historical context of its earliest elabora-
tions and reflect on itself, based on its contemporary practice. In L’écriture de l’histoire (1975), Michel
de Certeau incites each body of knowledge to do the same:
« La nature d’une science [est] le postulat à exhumer de ses procédures effectives [. . .] Faute
de quoi, chaque discipline serait identifiable à une essence dont on présumerait qu’elle se pose
dans ses avatars techniques successifs, qu’elle survit (on ne sait où) à chacun d’eux, et qu’elle
aseulement avec la pratique une relation accidentelle ». ([51], p. 115)
These lines of approach for a theory of care/cure in psychoanalysis that I’ve proposed in this paper
could allow us to imagine a psychoanalysis that would not be adulto-neurotico-analytico-centered.
I hope to have demonstrated that, although the ideals that have been generally invested suggest
otherwise, this was the case for Freud’s own practice: his texts – and his correspondence, to an even
greater degree15 – preserve the traces of this. In sum, my goal here was to make the case for the
pragmatic figure of a clinician Freud, which has often been obscured by the desire for the figure of
Freud as a “pure analyst,” supposedly liberated from the multiple constraints of care.
Disclosure of interest
The author declares that he has no competing interest.
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Social Sciences & Humanities Open 4 (2021) 100206
Contents lists available at ScienceDirect
Social Sciences & Humanities Open

journal homepage: www.sciencedirect.com/journal/social-sciences-and-humanities-open
An introduction to the postmodern paradigm via contrast to the modern

paradigm: Relevance for direct social work practice
Phillip Dybicz a, *, J. Christopher Hall b
a
Department of Social Work, University of Northern Alabama, USA
b
School of Social Work, University of North Carolina Wilmington, USA
A R T I C L E I N F O A B S T R A C T
Keywords: Since the late 1980s, a number of innovative practice approaches have appeared on the social work scene
Paradigm informed by postmodern thought. Yet the esoteric nature of postmodern theories often creates difficulties in
Postmodern accessibility for social work students and practitioners, which commonly result in the misapplication and
Strengths
misunderstanding of key elements to these approaches. To remedy this situation, this paper offers an intro
Narrative
duction to the fundamental philosophical foundation upon which postmodern theories and practices rest.
Designed as an aid for students and practitioners who wish to try or refine these practices, the description of this
philosophical foundation—or paradigm—is light on concepts and focuses more on implications for social work
practice that arise from the concepts. Examples of these implications are given for each aspect comprising the
postmodern paradigm utilizing the following: the strengths perspective, narrative therapy, and solution building
therapy. Lastly, the article concludes with an extended case example which serves to illustrate the application of
the postmodern paradigm to practice.
1. Introduction shift if the paradigm one is attempting to shift to is left undefined or

vague? While there is much social work literature out there elaborating
In the past 30 years, a number of innovative social work practice upon various postmodern theories and how they inform social work
approaches have been developed that challenge the traditional ways of practice (e.g (Bell, 2012; Chang, 2010; Danto, 2008), very little of it is
approaching practice. The strengths perspective, narrative therapy, and written at a level that is easily accessible to the beginning student or
solution building therapy are three prominent examples of this move practitioner [e.g. 7,8] and no literature could be found that specifically
ment. Proponents of such innovative approaches call for the practitioner offers a description for beginners of what comprises this postmodern
to undergo a “paradigm shift” in the understanding of social work paradigm.
practice in order to avoid misapplications and to bring to bear the full Our purpose therefore is to offer an introductory description of the
power of these approaches (e.g. Gabels & Peters, 2004; Weick, Kreider, postmodern paradigm as means to increase understanding of the inno
& Chamberlain, 2006). First utilized in this way by Kuhn (Kuhn, 1962), vative social work practices stemming from postmodern thought. At its
a “paradigm” is defined as a philosophical framework for understanding most basic level, an understanding of the world (i.e. paradigm) must
the world at its most basic level. The “shift” being called for is the answer three basic questions. First, what makes something real?2 Sec
movement from a modernist paradigm—a scientific understanding of ond, how do we know what we know? Or in other words, how do I know
the world—to a postmodern paradigm: a humanistic understanding of if my perception of reality is accurate?3 And third, how does change to
the world.1 But how can a student or beginning practitioner make this reality occur? Or in other words, how do we understand causality? The
* Corresponding author.
E-mail address: pdybicz@una.edu (P. Dybicz).
1
This scientific understanding refers to the theories, such as behaviorism or systems theory, that arise from the Modernist philosophical foundation, or paradigm.
The humanistic understanding arising from the Postmodern philosophical foundation (i.e. paradigm) refers to the theories which arise from it, such as Foucault’s
notion of power or Derrida’s concept of the absent but implicit, that are based in the disciplines of the humanities (i.e. history for Foucault, and literary studies for
Derrida).
2
In philosophical circles this is known as a theory of ontology (reality).
3
In philosophical circles this is known as a theory of epistemology.
https://doi.org/10.1016/j.ssaho.2021.100206
Received 19 July 2021; Received in revised form 8 September 2021; Accepted 9 September 2021
Available online 24 September 2021
2590-2911/© 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
P. Dybicz and J.C. Hall Social Sciences & Humanities Open 4 (2021) 100206
philosophical theory of causality in both the modernist and postmodern 2.1.1. Implications for social work practice
paradigm is particularly important for social workers in that one’s un There are two important implications that flow from this stance of
derstanding of causality informs one’s notion of how change is achieved. scientific objectivism. First, objective knowledge does not require one to
It must be noted that the paradigm shift called for by postmodern apply value or judgment to understand reality—rather, it aims for a
practices does not require one to disavow a scientific understanding of value-free stance.5 The reality of gravity, or the classroom chair, does
the world as incorrect or invalid. While critiquing the shortcomings of a not depend upon my judgments of their usefulness to me. Second,
scientific approach, postmodernism is not anti-science. The argument objective knowledge is not bound by time; it is eternal. Thus, gravity is
put forth by proponents of postmodern practice is simply that there is recognized as always having existed and operated in nature, operating
more than one, or best way, to understand the world. And that a post well before Newton discovered the formula to describe it. We recognize
modern understanding of the world—and the practices that flow from gravity as a scientific fact—the timeless nature of this truth is what
it—may be better suited toward meeting some of the goals and the grants it validity. This understanding of reality is sometimes colloquially
mission of social work. referred to in writings as Truth with a capital “T” to signify the process of
how an object’s existence is being claimed as a scientific fact. New sci
2. The modernist paradigm entific discoveries may change our understanding of an object’s exis
tence, for example gravity (such as Einstein’s theory replacing parts of
The modernist paradigm is currently the premier paradigm influ Newton’s theory), but this simply reflects the progression of a more
encing social work practice: it defines the present historical era’s foun accurate means to measure the object; thus the new understanding re
dational philosophical understanding concerning reality, knowledge, places the old. The goal of research is to add to this body of objective
and change. Hence, for people who are not well-versed in philosophical knowledge, thus we as social workers then turn to this body of scientific
inquiry, the modernist paradigm necessarily becomes the default un facts (and theories) in order to inform our practice. So for example,
derstanding of one’s world. Thus, while students and practitioners may research studies may make the truth claim that corporal punishment is
be unfamiliar with the philosophical names attributed to some of the the least effective means in which to shape a child’s behavior. We then
theories described in this section, the concepts that comprise them use this understanding of reality to guide our efforts when working with
should not be difficult to understand as they are concepts that we have clients who are seeking to shape the behavior of their children.
all been exposed to since grade school. In very broad terms, the
modernist paradigm can be described as an evidence-based approach to 2.2. Modernism on knowledge creation
practice.
While a theory of reality speaks to the composition of reality, a
2.1. Modernism and reality theory of knowledge creation speaks to how to develop certainty that
one’s perception of reality (the image of the object’s existence that one
On the most simplistic level of understanding, something is real if it forms in one’s mind) is in fact accurate, or true; for example, how do I
exists. Thus I can objectively recognize its various properties of existence know the classroom chair in front of me really exists and is not a
by employing some of my senses (or tools that aid my senses). Note, we hallucination on my part? Objective knowledge in one’s mind is vali
are not specifically saying physical properties of existence—although dated via an appeal to other minds achieving the same image of reality.
this is the most common form, we can also recognize the reality of This appeal is made via careful and accurate observation, experimen
depression for example. Even though depression does not have a phys tation and discussion. Positivism is the theory that informs the
ical embodiment, we can employ tools to objectively measure its exis modernist paradigm in this regard. Briefly, positivism states that the
tence and in the process treat it as a de facto object. truth claims of objective knowledge are validated via positive verifica
When we think of truth, it is equated with reality. Thus the objective tion by others (Popper, 1963). This verification takes place through
truths offered by the modernist paradigm are often described as scien observation—by duplicating the observation and experimentation of
tific facts. As the name implies, objective truth takes the stance that others, a truth claim is validated when the same image (i.e. knowledge)
knowledge of reality lies within the object of study—it is what philos is created in the additional person’s mind. As the truth claim begins to
ophers term mind-independent in that the brain simply acts as an organ consistently yield the same result it grows in strength (from hypothesis,
in which to record reality: it does not play an active role in creating the to theory, to natural law—e.g. the law of gravity). The use of one’s
reality of the object (Popper, 1972). This stance is named the corre senses (i.e. observation) to obtain and verify knowledge is known as
spondence theory of truth—reality is understood to the extent that the empiricism.
image one forms in one’s mind (through accurate observation) corre
sponds to the actual properties of existence for the object (Prior, 1969). 2.2.1. Implications for social work practice
Thus, for example, when I view a chair in the classroom, I recognize the Positivism continues to emphasize the timeless nature of objective
reality of its existence due to the inherent properties of the chair (e.g. its truths first outlined in the section on reality above via the correspon
dimensions, the composition of materials used to create it, etc.). It has an dence theory of truth. As stated in the previous section, within the
existence, and will continue to exist, whether or not I am in the room to modernist paradigm, intervention efforts are geared toward manipu
observe it. This scientific approach to understanding reality is known as lating the clients’ properties of existence according to scientific facts (i.e.
objectivism4: Knowledge simply of properties of existence can be timeless truths). As revealed in this section, the route to do this is via
thought of as static knowledge. When we combine it with a theory of careful observation (properties can be directly or indirectly observed).
causality we can also observe objective knowledge of movement—such So for example, a staple of traditional social work practice includes
as gravity—and proclaim it as a scientific fact (i.e. truth). In both cases, conducting a bio-psycho-social assessment. This occurs during the
this knowledge exists out in nature waiting to be discovered by assessment phase. The bio-psycho-social assessment is a tool designed to
scientists. aid the social worker in gathering observations of biological, psycho
logical, and social properties related to the client’s problem. The data
4
Note, this is not the objectivism used by some philosophical political po
5
sitions, such as the rational individualism of Ayn Rand, which builds upon the Recent critiques, emanating from postmodern thought, have demonstrated
core concept of objectivism presented here (i.e. rational determination of re the impossibility of achieving a truly value-free stance; however, to do so re
ality) and offers further elaboration to it by pairing it with a libertarian political mains the ideal and the task becomes that of eliminating bias from one’s ob
philosophy. servations as much as possible.
2
obtained by this careful observation is plugged into appropriate models one toward attempts at diagnosing the presenting problem as the pri
of human functioning (timeless truths), yielding a plan of action (at the mary means to foster change.
level of hypothesis) on how to manipulate these properties of existence
to achieve the desired change. Another example is evidence-based 3. The postmodern paradigm
practice. These are practice approaches that—through repeated obser
vations of their effectiveness in manipulating the properties of concern As will be discussed presently, there are many experiences we have
for a particular population group—lay claim to the status of an objective in life that do not fit within this modernist understanding. Yet these
(i.e. timeless) truth (at the level of hypothesis or theory). Both of these experiences—when under the influence of this dominance of under
approaches will be elaborated upon in greater detail in the following standing—will fade to the background and be given very little consid
section on causality. eration. The postmodern paradigm, through offering a different
understanding, seeks to privilege these experiences that heretofore have
2.3. Modernist theory of causality gone unrecognized. By fundamentally understanding the world in a
different way, it offers a radically new way in which to conceive of social
For our purposes as social work practitioners, the key element to be work practice.
analyzed within a theory of causality is what it has to say concerning
human behavior (i.e. human action). The notion of cause and effect has 3.1. Postmodernism and reality
been around since the time of Plato and Aristotle, if not longer. But its
most recent elaboration within a scientific context can be attributed to Phenomenology 7 is the philosophical theory of reality undergirding
Newton’s laws of rational mechanics (Newton, Whitman, & Budenz postmodern social work practice. Phenomenological knowledge aims at
Trans, 1999), formulated in terms of action-reaction. Vernacularly, this capturing the subjective truth of everyday experience (Sokolowski,
is understood as cause and effect: there is a cause (i.e. movement of 2000). In contrast to scientific knowledge, phenomenology takes the
physical properties of existence) that has an effect on the object(s) with position that knowledge of reality is in part subjective: It arises in part
which it interacts producing a change in that object (i.e. movement of from the subject who is seeking understanding. Also in contrast, it re
physical properties of existence). The classic example used to illustrate is quires one to make a value judgment and it is a time-bound truth (not
that of a billiard ball hitting a group of other billiard balls as it represents eternal). The following anecdote will illustrate these concepts:
a more complicated nonlinear causality. The various billiard balls
bouncing around and hitting each other attempt to capture the chaotic You are in a social work class at the university. As this is a three hour
interplay of causes found in real life when it comes to attempting to long class, the instructor gives a break midway through. You take
explain human behavior. advantage of the break to leave the room and make a phone call.
When you return, you are a bit perplexed and perhaps a bit offended
2.3.1. Implications for social work practice to find that another student is sitting in the chair where you were
A Newtonian view of causality results in a focus on the client’s bio- sitting before the break. You politely tell the person to vacate the seat
psycho-social properties of existence. Change in human action is seen as you were sitting in it previously.
as arising from the manipulation of these properties to successfully The experience of laying claim to a chair or seat is a common,
adapt to one’s environment. Thus the social work intervention dons the everyday experience in which we can relate. The reality of this everyday
mantle of an endeavor at problem-solving—causal mechanisms guide experience is what phenomenology seeks to capture. In the above sce
the manner in how to produce the desired change in client actions. As nario, when you return to the class and find a student sitting in your
Turner and Jaco (Turner et al., 1996) note, “It [the problem-solving chair, you are not looking at the chairs scientifically. A scientific,
approach] seems to have been so completely absorbed into much of objective understanding of the chairs in your classroom would view
social work thought and process that it has essentially become the basic them—having the same physical structure and all coming from the same
method that underlies much of practice” (p. 519). Evidence-based manufacturer—as essentially the same. Being the same, it would not
practice also arises from this notion of causality: an attempt to amass matter to you which chair you sit in. This scientific view does not fully
repeated observations of causal linkages in order to create timeless capture our human understanding of everyday experiences in the world.
truths which can then be applied to clients who face a similar issue of In the everyday experience of phenomenology, you still recognize
concern. the physical properties of the chair’s existence, but in addition, you
Now that the modernist theories of reality, knowledge creation, and make a judgment about the chair—claiming it as yours to sit on. The
causality have been elaborated, it can be demonstrated how they fit reason for this is that in everyday experience, we do not simply view
together and complement each other. The correspondence theory of objects impartially, but rather we interact with them and seek to use
truth combined with a Newtonian understanding of causality describes them. In so doing, we are required to make a judgment about their use.
how properties of existence are subject to change. Positivism is then This judgment arises within the subject (i.e. the person), thus making
relied upon to provide the certainty that these observed changes are in this a subjective truth claim. The truth claim of “my chair” is also time-
fact true. So for example, if I burn a piece of paper I am breaking bound—its truthfulness exists solely for the period of time you spend in
chemical bonds and creating a new existence: ash. Similarly, organisms class on that occasion.
can be induced to change their behavior or environment; to do so, one While your subjective truth claim of the chair being “yours” relies
looks for factors (similar to bringing flame to the paper) that will result upon judgment, this does not mean that all subjective truth claims are
in the desired change. For human beings, this factor is usually the equally valid. As will be illustrated in the next section on social con
employment of reason6—by understanding the various elements structionism, by having sat in the chair first (a social convention), our
contributing to one’s problem one can eliminate negative elements and
adopt positive elements to achieve the desired outcome. This under
standing of reality is what informs such approaches as cognitive- 7
The theory of phenomenology has been around since the time of Plato.
behavioral therapy, and at a much broader practice level, what directs When I refer to phenomenology here, I am referring to its most recent articu
lation, starting with the works of Husserl and Heidegger. They moved away
from what they called the “natural standpoint”, and toward a notion that
6
David Hume is the philosopher best know for articulating the connection essence arises within language and dialogue via the value we attribute to
between the employment of reason to understand causal connections in regards phenomena. The result of this dialogue often takes the form of agreed upon
to explain human actions. social conventions.
3
culture deems your claim as the valid one. Appealing to this social judgments) of that reality. This too will be elaborated upon in the
convention, you are even able to provide evidence of arriving first via following sections. By contrast, as stated earlier, traditional approaches
various personal items you had left under the seat. relying upon objective knowledge seek change by fostering a change in
Subjective truth is simply a different kind of truth, not necessarily a the existence (i.e. physical properties) of the client’s reality. This is from
lesser truth, or mere opinion. Utilizing judgment does not diminish the where the person-in-environment8 model of practice arises.
reality of the chair; in fact, it enhances it. The modernist paradigm’s
understanding of reality views objects as solely possessing properties of
existence. Similarly, phenomenology views phenomena such as the 3.2. Postmodern theory of knowledge creation
chair as comprising an existence (physical properties and their move
ment) but in addition, an essence (a judgment made about these prop The postmodern theory of knowledge creation must answer ques
erties) as well. As way of further illustration, let’s examine a more tions such as “How do I know that my understanding of a $20 bill as legal
durable subjective truth in our everyday experience: a $20 U.S. bill. tender is correct (i.e. real)?” As is the case with objective knowledge,
Looking at the $20 bill scientifically, we can definitively state various subjective knowledge is validated via an appeal to other minds
properties of its existence: it is made of paper; it has a serial number; achieving the same image of reality (e.g. the worth of a $20 bill). Social
words and images are printed in green ink; the words “twenty dollars” is constructionism is the theory employed in the postmodern paradigm to
printed on it; etc. No matter what the historical time period, these are achieve this assuredness. As we are not only dealing with an existence (i.
properties of the $20 bill that would not be refuted. However, in our e. various inherent properties) to reality, but also an essence (i.e. value
everyday experience, we ascribed a value judgment to the $20 bill—it is judgments), validation does not come from observation alone. Social
legal tender of a certain worth. This subjective truth claim is not simply conventions and rules—and the value judgments arising from them—are
mere opinion—a shop keeper cannot legally refuse your $20 bill and constructed in the social arena (hence the term “social construction
demand only gold or silver. The value inherent in a $20 bill is a sub ism”). Thus, validating a subjective truth claim does not rely upon
jective truth claim validated by various rules and conventions in our agreement of observation, but rather, upon agreement of observation
society. It is a reality that fits the phenomenological formula of requiring and meaning-making (Gergen, 1999). Therefore, according to Scott
a judgment, being time-bound, and arising in part within the subject. (Scott, 1976), making a subjective truth claim is an exercise of rhetoric;
While much longer lasting than the earlier truth claim of “my chair,” it is a sharing of knowledge concerning cultural traditions.
the inherent value of a $20 bill is not eternal. If we imagine a scenario of This is not the vernacular understanding of rhetoric: which amounts
going back in time to Colonial America and showing a $20 bill to peo to the art of persuasion. Rather, the philosophical understanding of
ple—they would recognize its various properties of its existence (i.e. rhetoric refers to the mechanics of meaning–making. Rhetoric involves a
paper, green ink, etc.), yet they would not recognize its current essen careful and creative organizing of observed events into a narrative to
ce—an inherent worth as legal tender. The time-bound nature of the create meaning via a theme. Thus, rhetoric in this vein seeks to validate
inherent worth of a $20 bill does not make it a “lesser” or “less reliable” the essence of objects. The theme of this narrative speaks to the
truth than the objective truth of gravity’s existence. Nor does making a particular situation of everyday experience from which the subjective
subjective truth claim about the $20 bill somehow invalidate the sci truth claim arises, and makes a case for its validity. So for example, your
entific, objective truth claim about its properties of existence; rather, as truth claim that the chair is “yours” is validated through stating the
stated above, it adds to it, thus enhancing it. following observed events: sitting in the chair from beginning of class
until the break, the eyewitness of other students to this event, and your
3.1.1. Implications for social work practice personal items underneath the seat acting as physical evidence that this
One important implication arising from the time-bound nature of indeed occurred. These observed events gain their relevance for inclu
subjective truth claims is that the social conventions and rules validating sion in the narrative, and the power to validate the subjective truth
them are subject to challenge and thus can be changed (Hence, in the claim, by contributing to the theme that speaks to the relevant social
above anecdote, the student occupying the chair where you previously convention: In this case, whoever arrives first in a chair has rights of its
sat could put forth a contesting social convention: e.g. “shuffle your feet, use until that person definitively exits that public space.
lose your seat”). If the rest of the class and the instructor adopted this One important implication that arises from Scott’s (Scott, 1976)
new convention, then the interpretation of the student’s action would go conception of rhetoric is the following. In contrast to objective truths (e.
from being rude to being assertive or crafty. Subjective truths are g. the physical properties of the chair), social conventions gain their
malleable. Change in this area can lead to change in a client’s actions truth status via a common commitment by members of society to uphold
and life situation. The strengths perspective (Saleebey, 2008) and other these conventions. Consequently, human beings are not bound to social
postmodern approaches (De Jong & Berg, 2008; White, 2007) seek to conventions; as subjective truths, social conventions are open to change
challenge social conventions that serve to undercut the client’s ability to by the humans that use them. This means that rhetoric has a reciprocal
take action to improve their lives. The details upon how this occurs will relationship with social conventions (Scott, 1976). Hence, a powerful
be elaborated upon more fully in the case example provided in the final rhetoric—how one chooses to organize the events of a situation (i.e., the
section. “story” one tells)—can favor one particular social convention over
In addition, the first major difference between postmodern ap another. Thus for example, you make an appeal to the instructor that the
proaches to practice and traditional, modernist approaches is revealed. chair is “yours” to sit on because you laid claim to it first. However, the
By challenging social conventions, postmodern approaches seek change instructor organizes the key events within a different theme: The
in the client’s reality by fostering a change in the essence (i.e. value instructor informs you that prior to your return she announced a class
room activity in which students were assigned groups and the groups
8
Person-in-environment comes from ecological systems theory, which builds
upon general systems theory, and thus has a firm scientific base. When
employing it as a model, one is able to take into account many such charac
teristics that don’t possess a physical embodiment such as socio-economic
status and even language itself (e.g. verbal abuse); however, in doing so, as
was the case for understanding depression earlier, we treat these characteristics
as de facto objects which we are then able to plug into the scientific under
standing of causality as cause-effect.
4
assigned to meet in certain areas of the classroom. Thus the same key acts. In addition, if I view myself as being kind, I will be motivated to
events (i.e. you having sat in the chair before break, personal items left perform kind acts. So there is a reciprocal relationship between human
behind, etc.), yet organized around a different theme and social action (movement of properties of existence) and human identity
convention (i.e. the instructor determines rules of participation in the (essence). Mimesis literally translates as “imitation.” As applied to
classroom), yield a different subjective truth: the claim to the chair be human action, this imitation has two parts. First, humans have the
longs to the other student. And thus, the essence of the chair is changed; ability to form images in their minds. As an outgrowth of a person’s
consequently, the other actions are now viewed as assertive rather than goals, this reciprocal relationship between action and identity means
rude and aggressive. This example outlines the important difference that a person will form an image in one’s mind of “who I am” and “who I
between subjective truths and objective truths. Being time-bound, sub want to be.” Furthermore, the images of “who I want to be” will be
jective truths are malleable—they can be changed by applying a circumscribed by realistic appraisals of “who I can be”. Secondly, the
different narrative to the observed events. Objective truths are timeless: person will then be motivated to imitate the “who I can be” by
change occurs through alteration of the properties of existence. employing free will to perform the appropriate actions. Within post
The above example also addresses a conundrum for many students modern practice, assisting the client in exploring empowering images of
learning about social constructionism and trying to grasp its main “who I can be” is the main vehicle to promote change.
concept: that it is possible to construct multiple realities. What is being Ricoeur (Ricœur, 1984–88) offers the most recent elaboration of
constructed are multiple essences not an object’s properties of existence. mimesis. Ricouer argues that the creation of essences (both that of chairs
A phenomenological viewpoint offers the following conception of re and human identity) occurs within a narrative structure. So for example,
ality: reality = existence + essence. As was illustrated using the example if someone should ask me how my day has been, I do not respond by
of the classroom chair, if you change the second part of this equation giving a second by second account of everything that happened to me.
(the essence of the chair) in multiple ways (place it under various social Rather, I would selectively choose events to relate that would corre
conventions), even though the existence of the object (i.e. the physical spond to my value judgment of my day as “good,” “bad,” or “okay.” A
properties of the chair) remains the same throughout, this will result in narrative is exactly this: the selection of events to relate to an audience
multiple realities (multiple understandings of what the chair can be). (not only significant others in one’s life, but oneself acts as an audience
to one’s own narratives, judging their verisimilitude). Ricoeur (Ricœur,
3.2.1. Implications for social work practice 1984–88) further argues that this natural proclivity to place human
Whereas modernist approaches to practice seek to foster change via action within a narrative structure means that human action is always a
the manipulation of properties of existence, postmodern practice ap comment upon human identity (as this is the nature of narrative).
proaches seek a change in the essence of reality to promote change in the Furthermore, if key events of a narrative are “bookended” by new sup
client’s situation. Thus we can see now the beginning outlines of the plementary events, a change occurs to the essence of the phenomenon
paradigm shift in understanding that is being called for by postmodern (e.g. from the chair as being yours to being the other student’s) and the
practitioners. As revealed in this section, the route to do this is through actors (e.g. the other student going from being rude to being assertive).
rhetoric. When one employs rhetoric, additional observed events are Witnesses to this bookended narrative (i.e. audience members) who
sought to “bookend” the key events of the client’s situation. In the agree to its verisimilitude, further validate this change in subjective
anecdote above, this occurred when the instructor rhetorically added to truth.
the key events of your particular situation by providing the additional
observed event of the announced classroom activity; by acting as a 3.3.1. Implications for social work practice
bookend to these key events, the announced classroom activity changed Modern and postmodern theories of causality both speak to efforts at
the essence of the chair. changing reality. As one of the defining features of social work is that of
A strengths assessment is one example of a vehicle to aid in the fostering change, the paradigm one employs to understand our world
employment of this rhetoric. The strengths assessment is a tool that aids has profound implications concerning directing one’s efforts at fostering
the social worker and client in finding observed events that reflect client this change. The theory of reality being employed will determine the site
successes and strengths in which to “bookend” the key events of the of these change efforts: properties of existence (modernist practice) vs.
client’s current problematic situation, and in so doing, create a new essence (postmodern practice). And one’s theory of knowledge creation
theme of empowerment and resilience to replace that of dysfunction or concerning reality will determine the form of change efforts: observation
despair (Rapp & Goscha, 2006). Solution building therapy follows this alone in order to successfully manipulate properties of existence, versus
same route—seeking events that reflect client successes—via its search the rhetorical organization of observed events in order to construct an
for “exception” times (Saleebey, 2008). Narrative therapy does the same empowering client essence which then is drawn upon to induce changes
via its search for “unique outcomes” (White, 2007). In all of the above, in existence.
clients’ actions change in response to the created change in their Drawing upon the theory of mimesis, postmodern practice ap
essence. Thus, the postmodern practice of rhetoric with clients becomes proaches seek change in human action via its reciprocal relationship
a cooperative endeavor at constructing a more empowering identity of with identity (i.e. essence of being human)—helping the client to move
the client, in which, this new understanding of identity serves as a source away from disempowering identity formulations and embrace empow
of power to enact change. Once this change in essence occurs in the form ering identity formulations based upon the client’s strengths and suc
of a more empowering identity, clients can marshal their inner spirit and cesses. This move is captured well by Saari (Saari, 1991):
employ free will (i.e. personal agency) in creating change to the exis
The perspective taken in this book asserts that the adaptive point of
tence of their problematic situation. Greater elaboration of this dynamic
view has provided an inadequate foundation for clinical social work
is illustrated in the following section on causality.
theory. A theory of meaning in which psychological health is indi
cated by a constructed personal meaning system (or identity) that is
3.3. Postmodern theory of causality
highly differentiated, articulated, and integrated is proposed to take
the place of conceptualizations about adaptation (p. 4).
Mimesis, the postmodern theory of causality, also traces its lineage
back to Aristotle (Aristotle & Heath Trans, 1996) and the ancient Greeks. For example, narrative therapy (White, 2007) accomplishes this via
A major quality that distinguishes mimesis from a Newtonian causality its technique of externalizing the problem, solution-building therapy
is that mimesis seeks to solely describe human action. Aristotle’s first (De Jong & Berg, 2008) via the miracle question. Both techniques aid
important premise of mimesis is the following: a person is defined by clients in forming images of themselves absent reflections of the
one’s actions. Thus, we say a person is kind when we see them do kind
5
problem. Just like an image of myself as being kind will motivate me to These individuals, almost without exception, began to construct a
pursue kind acts, clients’ images of themselves absent the defining in life—collaboratively—that no one could have predicted. The inter
fluence of the problem inspire them to act in a manner that leads to the esting thing is that they did this “in spite of their illness.” In fact, their
problem’s resolution. This dynamic is captured well by the following symptoms may have occurred at the same level, but the other parts of
quote from the strengths perspective (Saleebey and Saleebey’s, 2006a): them became part of their unfolding story: “me as employee,” “me as
piano player,” “me as driver,” “me as spouse and parent.” The
In a sense, what is happening at this point is the writing of a better
symptoms move into the background of a much richer symbolic
“text.” Reframing is a part of this; not the reframing of so many
ecology (p. 357).
family therapies, but adding to the picture already painted, brush
strokes that depict capacity and ingenuity, and that provide a
different coloration to the substance of one’s life (p. 89). 5. The postmodern paradigm illustrated: a practical application
The various parts (theories of reality, knowledge creation, and cau

4. The required paradigm shift to practice postmodern
sality) of the postmodern paradigm at work are nicely illustrated by a
approaches
clinical social work case of mine (Chris Hall) involving an eight-year-old
boy (Jude) who was brought in by his parents for “acting out.” Despite
With both the modern paradigm and postmodern paradigm having
visiting a number of different traditional therapists, the problem had
been explicated, we now are at a point to understand the clear difference
become intractable. In fact, the boy had been diagnosed with opposi
between modern and postmodern practice approaches and the required
tional defiant disorder by a former therapist and the parents had been
shift in one’s understanding of the social work helping situation that is
told that this disorder is commonly a precursor to conduct disorder,
needed to move from a modernist practice approach to a postmodern
which in turn could eventually manifest into anti-social personality
practice approach. The following table summarizes these differences
disorder when Jude turns eighteen. This information only exacerbated
and the implications that arise from adopting a fundamentally different
the parents’ worry. Also Jude, who had begun to see himself as having
premise for one’s understanding of reality, knowledge creation, and
an unavoidable disorder, started to believe that he was a broken child
causality.
who could not be repaired (Jude’s essence as socially constructed
Traditional modernist approaches to practice are an endeavor at
around the disorder). His main identity feature became that of the
problem-solving (Turner et al., 1996). This is why diagnosing the pre
disorder.
senting problem is so important, as understanding the causal linkages
Over time, Jude had begun to experience daily incidents of “acting
will hopefully lead to possible solutions. Once these solutions are arrived
out” and his parents believed he had given up. The social convention
at, change will occur via an appeal to the client’s reason (e.g.
related to his behavior was the following: “Normal eight year olds don’t
cognitive-behavioral therapy)—if clients are able to understand how
throw tantrums and can control their emotions in this regard.” This is a
these solutions will ameliorate their problem, their reason will direct
social convention—arising from everyday experience—that few in our
them to employ the solutions.
society would contest. It is a requirement for continued enrollment in
The paradigm shift being called for by postmodern practitioners is a
schools and the rationale behind traditional interventions such as
call for moving away from the modernist approach: adopting a problem-
behavioral charts and token economies for 3–4 year olds who exhibit
solving approach, diagnosing the problem, and appealing to the client’s
this behavior (Skinner, 2011). In addition to painting Jude as abnormal
reason as the main tools for fostering change. To repeat, one’s theory of
in relation to this behavior, the additional value judgment of being a
causality directs one’s notion on how change occurs. This makes post
“bad” boy arises from the correlative social convention: “Good boys
modern interventions endeavors at consciousness raising (e.g. exploring
don’t throw tantrums and act out against their parents.” We see this
empowering images of “who I can be”). Consequently, change does not
convention at work in the process of raising children. A parent may
occur through an appeal to the client’s reason, but rather through an
praise a child’s listening and agreeability by saying, “You’re such a good
appeal to the client’s imagination—exploring different ways to narrate
girl/boy!” So in relation to his observed events of “acting out,” the
the client’s problematic event. This serves to empower clients and to
essence created for Jude in his mind is that he is abnormal and a bad boy,
highlight the various capacities they have for change. Thus exploring
and this was reified by the traditional mental health system. This dis
client goals and dreams (images of who I want to be) as well as strengths
piriting identity formulation for Jude gave him the feeling that he was
and successes (empowering events in which to ‘bookend’ the new
unworthy of his parents’ love. Jude wants to be a “good” boy, but each
narrative being created) are the primary tools for fostering change. This
successive “incident” only serves to further confirm this negative iden
exploration is guided by a genuine curiosity to learn about these
tity formulation, giving him the sense that he is incapable of achieving
strengths and successes. Postmodern practitioners have come to describe
this goal. Consequently, Jude’s dispiritedness led to hopelessness in
this stance of adopting this genuine curiosity as comprising a “not-
taking action to achieve his desired goal and thus the problem worsened.
knowing” approach (Anderson et al., 1992). Once clients are able to
The parents decided to give counseling one more try before they
embrace this new image of themselves and of who they could be, they
turned to medication for Jude. In narrative counseling the technique of
are empowered to begin acting in such a way to bring about the desired
externalizing counters Jude’s hopelessness and creates space to explore
change. Again, a quote from the strengths perspective captures this
the problem in a way that does not pathologize him. This was done with
dynamic well (Saleebey, 1994):
Jude in session by asking him to conceive of the desire and behavior of
acting out as a malevolent force “outside” of himself. Jude named the
Philosophical Modern Paradigm Modernist Practice Implications Postmodern Paradigm Postmodern Practice Implications
Premise
Reality Properties of Existence Adopt a Problem-Solving Approach Properties of Existence Plus Adopt a “Not-Knowing” Approach
Targeting Properties of Existence Phenomenon’s Essence Targeting Client Essence/Identity
Validity of Confirmation of Appeal to Client’s reason Confirmation of Social Conventions Appeal to Client’s Imagination to Raise
Knowledge Properties of Existence in Determining Essence Consciousness
Causality Cause-Effect explains Diagnosing causes of Presenting Images of who I am and want to be Exploring Client Goals, Dreams, and
human action Problem motivate human action Successes to Empower Client Images
6
problem “the frustrations”—and explained that they convince him to and a future orientation based on the causal linkages to human action
perform emotional outbursts. The problem was then personified (White arising from client goals and dreams. As the title of this article states, its
& Epston, 1990) as having motives that were both helpful and hurtful to goal has been a simple one: to introduce beginning students and prac
Jude and his family. For Jude “the frustrations” sometimes help him get titioners to the foundational philosophical theories undergirding post
what he thinks is fair by making him feel bigger when talking to, “really modern practice approaches. Such understanding serves as an aid to
tall and strong people like my parents,” but they also get him in trouble better understand the literature outlining these practices (De Jong &
because “the frustrations” convince him that he has to scream and get Berg, 2008; Rapp & Goscha, 2006; Saleebey, 2008; White, 2007).
mad to be heard. The parents also realized that “the frustrations” affect The strengths perspective, in particular, laments the misuse of its
not just Jude but them as well. They realized that “the frustrations” like approach by those trying to apply it within a purely scientific framework
to separate Jude from them and one way that happens is that “the (Saleebey and Saleebey’s, 2006b). As such, strengths merely become
frustrations” convince them not to listen to Jude’s words when he is additional properties of existence fitting within a problem-solving
angry but to focus instead on negativity and respond in an angry way. approach; concerns over client identity (i.e. essence) and how these
The process of externalizing and personifying effectively excises the strengths speak to identity are consequently ignored. Thus, inquiring
negative feature from Jude’s identity and explores the purpose that the about client strengths while conducting a bio-psycho-social assessment,
problem could be serving in his life and in the life of the family. Jude had while laudable, is not employment of the strengths perspective; rather,
a belief that things were unfair and “the frustrations” were helping him the strength perspective would call for conducting a strengths assess
to be heard. Through the process of externalizing, the family was able to ment to be used by the client to explore empowering essences of “who I
discuss how they could all work together as a team with Jude to keep can be.”
“the frustrations” at bay by bringing in the value of “fairness” as the A postmodern understanding of the world provides the paradigm
social convention guiding their actions. The parents could work at shift in viewing identity as grounded in human action and vice versa, a
listening to Jude, making things fair in the family, and being clearer shift to which the strengths perspective and other postmodern ap
about why some of Jude’s requests in the family are met while others are proaches appeal. For narrative therapy, White (White, 2007) places
not. Jude could fight “the frustrations” by realizing that even though he strong emphasis on the role that personal agency (i.e. free will) plays in
doesn’t always get what he wants, he does get some things, and that his determining human action—and how this is a reflection of identity. And
parents sometimes say “no” not simply to punish him but because they within solution-building therapy, De Jong and Berg (De Jong & Berg,
care about him. His bedtime, for example, is necessary because sleep is 2008) unabashedly take a future oriented focus and adopt the stance
important for his health. The family decided together that “fairness” was that “We ask for fewer details about the nature and severity of client
the enemy of “the frustrations” and when, as a team, they focused their problems, and we do not ask for possible causes of the problem” (p. 17).
attention on “fairness,” then “the frustrations” did not bother Jude or the All three approaches move away from a project of diagnosing the client’s
parents as much! problem (i.e. determining cause-effect linkages) and move toward a
Through this narrative process a new social convention was con project of identity building as the means to change human behavior.
structed to account for the depiction of Jude’s behavior, “Good kids care This identity building occurs via “book ending” client narratives with
about and strive for fairness.” In addition, this new social convention various strengths and successes. The articulation of identity (i.e.
immediately labeled Jude as a “good boy”; he did not have to wait for the essence)—not a focus on adaptation—is the route that postmodern
resolution of the problem to find reachable his “who I want to be” of practices take to foster client change.
mimesis. This in turn spurred Jude and his parents into examining both
past successes he had had at keeping the ‘frustrations” at bay as well as CRediT authorship contribution statement
future strategies to do so in order to reach and maintain this image of
himself as a good, brave, and strong boy (and thus worthy of his parent’s Phillip Dybicz: Conceptualization, Formal analysis, Writing – re
love). Furthermore, Jude was no longer at odds with his parents because view & editing. J. Christopher Hall: Case study application.
he now had family allies as they all worked together to create fairness.
Jude and his family identified a few “unique outcomes.” This helped to
“bookend” this new narrative by recognizing past successes where he Declaration of interest
sought out fairness in a calm way, without the need of “the frustrations”
to be big or to be heard. This gave Jude the confidence that being brave The authors declare that they have no known competing financial
and strong is a realistic appraisal of “who I can be,” and that he had no interests or personal relationships that could have appeared to influence
need for “the frustrations” to make him bigger when seeking fairness. the work reported in this paper.
This new social convention depicting Jude as good, brave, and strong,
was agreed to by his parents and the therapist which served to References
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OUTLINE PENDEKATAN & TEKNIK KONSELING

A. Peta Konseptual Teori & Pendekatan Konseling

7 Diferensiasi dengan a. Keunggulan & dibanding teori lain:

B. Analisis Kritis Jurnal (internasional)

Pendekatan/teori konseling : Psikoanalisis

*Lampirkan Artikel yang saudara kritisi

ANALISA KASUS DONA

Kriteria analisis kasus adalah:

Disponible en ligne sur www.sciencedirect.com

Lines of approach for a theory of care/cure in

Keywords: Objectives. – “Mental health” is a crucial issue for today’ societies.

Results. – These “operational schemas” can be divided into two

Mots clés : Objectifs. – La « santé mentale » est aujourd’hui un enjeu crucial

Conclusions. – Face à ces deux écueils, la psychanalyse freudienne

As Kuhn writes in The Structure of Scientiﬁc Revolutions:

made explicit. [. . .] It is [. . .] particularly in periods of acknowledged crisis that scientists have

2. The fundamentals of Freudian clinical practice

2.1. Psychoanalysis as a practice of treatment

2.2. Psychoanalysis as a theory of treatment

2.3. Psychoanalysis as an act of caring for the other

3. Schemas of psychoanalytic caring

3.1. Universal operational schemas

• dynamic conﬂicts (between more or less contradictory speech acts);

3.2. Typical operational schemas

• neurotic (intrapsychic conﬂict – experienced as guilt-inducing, paralyzing, the source of complaints);

3.3. Unique operational schemas

4. Schemas of psychoanalytic curing

4.1. Etiological schemas

4.2. Therapeutic schemas

4.2.1. Schemas of the handling of quantity

4.2.2. Schemas of the handling of the transference

The author declares that he has no competing interest.

Contents lists available at ScienceDirect

Social Sciences & Humanities Open

An introduction to the postmodern paradigm via contrast to the modern

1. Introduction shift if the paradigm one is attempting to shift to is left undefined or

The various parts (theories of reality, knowledge creation, and cau­

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