chapter  9
Working Together: Integrating Relational Psychoanalysis and Traditional Substance Use Treatment in Harm Reduction Therapy
Pages 19

On December 22, 1897, Freud wrote a letter to Fliess in which he said of addictions to substances such as alcohol, morphine, and tobacco, “The doubt of course arises whether such an addiction is curable, or whether analysis and therapy must stop short at this point” (Freud, 1897/1957). Freud, at that time, was probably right. The techniques of classical psychoanalysis did not work well for treating addictions. Those suffering from addictions were left further and further behind as psychoanalytic technique developed to include free association in the service of accessing the unconscious; a neutral analyst who refrained from initiating content or making suggestions; and an environment, the couch, which was designed to facilitate regression. Clearly, the addictive use of dangerous substances needed an intervention that addressed them directly, not one in which crucial issues could be ignored for months or years until the patient raised it spontaneously. In addition, a practice designed to increase anxiety, such as traditional psychoanalysis was meant to do, could be risky for those whose response to anxiety is the use of a substance. Beyond this, classical psychoanalytic technique, which depends upon symbolic verbal interactions, does not work well with addicts who choose actionbased solutions to psychic distress and who tend to suffer from a lack of language with which to express their experience or emotions (Krystal, 1988).