The psychoanalytic method requires, on the analyst’s part, a core psychoanalytic stance, where the patient can be reached in a conjoint working-through process, allowing a gradual understanding of the feelings present in the consulting room. Clinical neuropsychoanalysis originated with the presumption that this sort of treatment is valuable for patients suffering from brain lesions. Arising from the practice of clinical neuropsychoanalysis, and responding to critiques of the implications of neuropsychoanalysis in general, the author proposes that neuroscience can positively impact psychoanalysis, but within limits. Specifically, neuroscience provides useful information and conceptual tools that may affect the parameters of treatment – psychoanalytic technique – but can only help indirectly to understand the inner world as the patient subjectively conceives it; in other words, it does not fundamentally impact the basic analytic method. This basic stance, kindled in the analyst by controlled identification with the patient (as exemplified by countertransference-based interpretations), is enhanced by the intrinsic capacity for empathy and introspection, on the part of the psychotherapist and progressively, it is hoped, the patient, even those with neurological impairments. Technique (whether derived from neuroscientific notions or from psychoanalytic theory) can only help to facilitate change in circumstances in which this core psychoanalytic stance is in place. A corollary to this is that, in certain circumstances, theory (be it neurological or psychoanalytic in origin) may even inhibit this crucial psychoanalytic process. This view is supported by revisiting Joseph Sandler’s ideas on the “theory of technique” in psychoanalysis and by examples taken from clinical practice with patients with brain injuries.
