From this central assumption it becomes clear that:
The relationship cannot be exhaustively defined, either by positive or negative description. This would limit the flexibility and potential for uniqueness.
Interventions cannot be prescribed which will be appropriate for all cases – or indeed for any one case.
The nature of the work is not to address symptoms but their unconscious roots, so outcome cannot be measured by the alleviation of symptoms – or even of distress – in the short term.
Unconscious attitudes and conflicts will be played out in the relationship with the analyst, which will affect the patient’s perception of what is happening.
The unique nature of each relationship rules out any foreknowledge of process, direction, or the outcome of the therapy.
Given the above points, the notions of contract, negotiation and transparency of process become ambiguous and complex. They are indeed part of the work but difficult to define in any standardised way.
Specific Comments:
Preparation – starting the therapy
Most of these points are problematic for psychoanalysis. There is an assumption that what is being said consciously is to be taken at face value; and this is in direct contradiction to the assumptions of psychoanalysis. As noted above, transparency cannot be taken for granted. Further to this, any notion of “success” in psychoanalysis is predicated precisely upon the breakdown of ordinary communication, which allows unconscious conflicts and attitudes to come into play. If we add to this the problems with predicting outcome, there is little chance of agreeing anything with the patient other than a very simple contract to meet regularly at agreed times for an agreed fee. Nothing more can be promised or guaranteed.