Reflections on Lacanian Psychoanalysis and Cognitive-Behavioral Therapy
I am often asked, but how do you combine Lacanian psychoanalysis with Cognitive Behavioral Therapy, they are such unrelated subjects.
In fact, some colleagues use the term Lacanian psychoanalysis to make jokes. I will try to express my opinion as simply as possible, since I have dealt with both cognitive subjects.
The truth is that I personally cannot understand how someone can express an opinion about something they have not studied. I also cannot understand how some people discredit the works of people who have spent their lives studying human nature.
Just as it is not wise to discredit Aristotle because he believed that all the functions of the human body emanate from the heart (instead of the brain, which is actually the case), nor Einstein who, after the theory of relativity, spent his career unifying all the forces of nature in a fundamental equation (it has been proven that this is not possible), nor civilizations and cultures that excelled with institutionalized slavery (e.g. Classical Greece), with the same reasoning we cannot discredit the works of diverse workers of humanity such as Freud and Lacan. It would be more useful if Cognitive-Behavioral therapists studied their important works and drew useful observations and conclusions that could open new paths for them in their psychotherapeutic practice.
Somewhere I had read an article by a respected colleague (psychiatrist) abroad, where he argued that we have now reached a saturation point in psychotherapeutic practice and where everything new is a variation of the old and somehow, in some way, this will have to be overcome in order to see spectacular changes with impressive results in modern psychotherapeutic practice. In Cognitive approaches there are many more than one and others are emerging every now and then (Schema therapy, ACT, DBT etc.)
Lacanian Psychoanalysis is called by many as the Social Theory of psychoanalysis. For me, Lacanian psychoanalysis was the bridge, the transition between classical psychoanalysis and the cognitive approach to the human psyche. For example, the position of the psychoanalyst Lacan was that man, beyond his physical existence, can also be understood as a system of knowledge and beliefs.
The fact that people continue to suffer from mental disorders, from antiquity to the modern era, despite such great technological progress and accumulation of new knowledge, shows us that there is something structural that has remained unchanged throughout all these years. It is this structural element that creates the intense feelings of fear, shame, anxiety and the like.
The structural, according to psychoanalysts, is the primary trauma, which acts as a "magnet" of those knowledges, assumptions, beliefs and personal "I believe" of the individual, that is, those that constitute the self, with the aim of protecting him from extremely threatening memories and experiences. Lacan argued that this function of the "magnet" is to create a protective armor that will protect us from our traumatic experience, which reminds us of the shape of an onion.
Therefore, in order to reach, process and heal the trauma, we must, within the framework of psychoanalysis, slowly reach the core of the "onion", systematically and slowly peeling it through the persistent process of psychoanalysis.
Aha! But that reminds me of something. Perhaps the vertical arc technique, a basic technique of Cognitive Behavioral Therapy that contributes to the cognitive restructuring of the subject, that is, the psychotherapist?
Οπου από μια αυτόματη σκέψη, που συμβαίνει σε κλάσματα δευτερολέπτου και ως εκ τούτου μη αντιληπτή, μια «ασυνείδητη σκέψη» - με ψυχαναλυτικούς όρους-, σε ένα ερέθισμα εσωτερικό ή εξωτερικό, του άμεσου περιβάλλοντός του ο ψυχοθεραπευτής καταλήγει σε μια βασική πυρηνική πεποίθηση που τον κάνει να δυσλετουργεί; Μια πεποίθηση βαθιά ριζωμένη που προέρχεται από την προιστορία, την αλληλεπίδραση του ασθενή με τους σημαντικούς άλλους των παιδικών του χρόνων; Βλέπετε ότι τώρα τα πράγματα, δηλαδή η Λακανική ψυχανάλυση και η Γνωσιο-Συμπεριφοριστική θεραπεία αρχίζουν ελαφρά να φαντάζουν λίγο εγγύτερα το ένα με το άλλο. Και συνεχίζουμε...
In Lacanian psychoanalysis, a signifier that represents another signifier, a symptom, therefore, represents a substitute signifier that must be deciphered through the chain of associations that will lead to other signifiers in the patient's discourse. But also in the GST, the topology of the symptom, such as the lowered gaze, should prompt the therapist to explore the hypothesis of a social phobia using his own tools and techniques until he arrives through a chain of associations at the so-called "hot thought". A "hot thought" could be something that carries a particular and absolutely personal meaning, on a symbolic level.
Another well-known teaching of Lacan is that “we are not masters of our own House”, where he considers our unconscious to be our home.
He means that when we start speaking we do not define exactly what we will express (words, utterance), hence the problems in our communication with others. In cognitive terms, we would say that he refers us to the cognitive errors that these automatic dysfunctional negative thoughts usually contain, whether regarding ourselves, others or the future in general. That is why Aaron Beck, in matters of communication with others but also ourselves, urges us to ask those questions, so that we can be sure of the meaning we have perceived. Lacan said that because communication is imperfect, the relationship between a man and a woman resembles a great misunderstanding that if we saw it in a movie, it would certainly be a comedy. The fact that discussions continue and never end is because problems continue to exist due to this imperfect communication ("communication is impossible," he said).
It is important to remember that all of Lacan's teaching revolves around the Symbolic Name of the Father and the Paternal Function.
In the Lacanian view, psychological problems are created and have as their reference our interaction with authority, the Significant Others in our early history. But also in Cognitive-Behavioral Therapy, the patient's prehistory and especially his interactions within the family environment are of paramount importance for resolving the patient's emotional and other problems.
In Cognitive-Behavioral Therapy, there is a change in an undesirable behavior that occurs gradually and according to the principles of Behavioral Science. It is a learning process in which the therapist is the guide through a process also known as "guided discovery" but also a model to imitate. He analyzes, describes and rehearses the desired behavior in the patient, and he in turn should try to repeat it between 2 sessions in order to become familiar with the object of his anxiety and fear.
In psychoanalysis, therapy occurs as a surplus value (surplous) of the entire process and over time, little by little... in a way, in the end the psychoanalyst "identifies", in a way, with his psychoanalyst, adopting ways of thinking and behaviors that allow him to make a structural change in his psychoanalysis. The two approaches to the same subject differ in terms of their methods, techniques and duration. The only case where the time of psychotherapy in the GST can last 2 and 3 years is in serious personality disorders where the patient has an inability / unwillingness / oppositional behavior to follow the instructions of his therapist.
And finally, wanting to answer the initial question, in a potentially beneficial way, to recall Gödel's incompleteness theorem.
Gödel proved that in a system there will always be propositions (our known axioms) on which we “build” further knowledge. In a system, says Gödel, there will always be paradoxes and propositions that cannot be proven within the system itself. It is in these cases that the introduction of knowledge from another field (system of knowledge) could satisfy this gap. When we talk about Cognitive-Behavioral Therapy and Lacanian Psychoanalysis, let us know that we are talking about two such, separate systems of knowledge (disciplines) and as such, the study of both subjects could – theoretically at least – contribute to modern psychotherapeutic practice without this being taken as a call for a “psychoanalytical” approach to Cognitive-Behavioral psychotherapy practice.
