Good M I
Harvard Medical School, USA.
J Am Psychoanal Assoc. 1996;44(4):1189-224. doi: 10.1177/000306519604400410.
Freud used the term suggestion in psychoanalysis in different ways, including suggestion as an integral part of the transference and suggestion in the sense of undue influence or technical error. This distinction can be expressed in terms of the patient's suggestibility (capacity for transference) and the analyst's unwarranted suggestion or persuasion representing countertransference, theoretical bias, or a departure from technical neutrality. Whether suggestion is explicit or implicit, the effects of suggestion and suggestibility may be mutual and reciprocal. To the extent that a psychoanalyst maintains the goal of technical neutrality, undue suggestion is likely to be minimal. To the extent that it occurs for transferential or countertransferential reasons, suggestion may itself be analyzed. Problems of suggestion are more likely to occur and persist when they are part of the analyst's theoretical orientation, influencing the course of the analysis and expressing compromise formations for both patient and analyst. At times, even tentatively stated words or unintended behaviors of the analyst can have a dynamic impact that may not be readily analyzed. The analytic situation itself may have retrospective (nachträglich) action. A previously published case is described in which an apparent enactment led the analyst to urge a reconstruction of sexual abuse even though the patient never actually recalled what was presumed to have been fellatio. The need for technical neutrality and alternative reconstructions in such cases is considered. The degree to which the personality and goals of the analyst influence the course of reconstruction remains a vexing issue for psychoanalysis as a scientific endeavor. There is a need for detailed analytic case studies in which alternative reconstructions can be compared by investigating opportunities for external confirmation or falsification.
