Fahey, Carmel (2006) Testing the therapist: an analysis of the patient’s attempt to direct treatment. PhD thesis, Victoria University.

Abstract

Much research has been conducted that explores the process of psychotherapy and psychoanalysis; however, there is little that provides an illustration of what actually occurs between patient and therapist. This research is an explanatory and descriptive study of testing, which Weiss (1993; Weiss et al. 1986) links to the transference. An analysis of the process of testing is presented from two theoretical perspectives drawn from the theories of Joseph Weiss (Control-mastery theory (CMT)) and Sigmund Freud and Jacques Lacan (Freudian-Lacanian theory). The primary research question asked: what is testing? CMT, based on the higher mental functioning hypothesis (HMF), proposes that testing is a phenomenon based on an assumption that the unconscious can think, plan and make decisions in the same way as the conscious mind. Freud’s later theory relating to the ego provides a theoretical framework for CMT and Freud’s early theory is used by Joseph Weiss as an alternative theoretical hypothesis to the HMF hypothesis. This thesis presents a comparative analysis of both theoretical positions, which revealed that testing was consistent with an unconscious transference demand. Two propositions were examined at a clinical level using data from a multiple-case study in which transcripts of the first ten sessions of each of three patients’ psychotherapy were analysed. The propositions were examined according to Yin’s rival theory and analysed according to the logic of pattern matching. The first proposition stated: (1) The Freudian-Lacanian theory of the transference would provide a fuller explanation of testing episodes than CMT. The second proposition related to what the patient wants of the therapist in testing and proposed that: (2) The patient wants the therapist to occupy the position of his parental object, which is the position of an identificatory object. Theoretically, testing in control-mastery theory is consistent with the Freudian preconscious but inconsistent with the Freudian unconscious. At a descriptive level testing was consistent with aspects of the psychoanalytic processes of acting out, projective identification, and repetition but inconsistent with these processes at a theoretical level due to differing conceptualisations of the unconscious. Clinically, testing as an unconscious process was most consistently explained in the case studies by Freudian-Lacanian theory in which it was viewed as the patient’s demand that the therapist occupy the position of the parental objects. This finding opposes the CMT assumption that in testing, the patient does not want the therapist to occupy the position of the parental objects. The opposing positions were explained by the different formulations of the unconscious, either admitting or omitting the drives, which underpinned different therapeutic aims in the two theories. As a theory of conscious and preconscious functioning CMT has merit, but the thesis concludes that it is not a theory of unconscious functioning. The implications of these findings for clinical practice and research are discussed.

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