The first chapter of Death instinct and knowledge (Fagioli, 2019) introduces original research. Starting from the common observation of a non conscious or behavioural patient’s reaction to the suspension of sessions in the context of the clinical routine, Massimo Fagioli deduces and writes: «The analyst is absent; The patient experiences frustration.» (Fagioli, p.15). The author explains the patient’s reaction to the physical absence of the psychotherapist introducing the concept of « psychological absence», defined in a new way as a «concept of non- being, of disappearance» (p.18). The definition of this concept opens innovative research on the therapist and their clinical praxis, which results crucial in the historical context of the moment. In fact, in 1966 Kiesler had already defined “myth” the assumption, shared until then, of the uniformity of the therapist qualifying as «devastating» the praxis of the psychotherapy research which selected psychotherapists for a research design, on the basis of the conjecture that these last would have been more similar than different, between each other. What could happen in the so-called real relationship, that is at a countertransference level in the therapist and in a feedback circuit in the patient’s mind, has been finally theorized only in 1971 with Death instinct and knowledge. Fagioli hypothesized in it a causal relationship between the concept of the psychological absence and the concept of frustration, making, however, a further specification. Indeed, he distinguishes the frustration of the “needs” of the patient, intended as a partial activity in the relationship, tending towards a direct satisfaction, determined by a pulsional activity aimed to not consider the human reality of the therapist, from the patient’s “requirements” of knowledge and psychic development. The opposition of the therapist to the patient’s needs satisfaction has been defined by Fagioli as “psychological presence “and “frustration-interest” towards the last one and on the contrary, the non- response to the human requirements of development of their mental reality is enucleated as “psychological absence” and “frustration-aggressiveness” toward them. This “non-response”, clarifies the author, « is not the lack of something but, rather, it is actively directing a pulsion, the death instinct, against the external object» (Fagioli 2019, p.24). The recognition of this dynamic of relationship allows definitively to understand what determines the difficulty to respond to the exigencies of development of the patient’s mental reality. Non- responsive because psychologically absent, it is therefore the therapist who « gives up comprehending and interpreting to take on the role of the Good Samaritan or of a pedagogue» (Fagioli 2019, p.23), or in their flexibility, do not realize that they are not opposing the satisfaction of needs. Their psychologically absence is the annulment pulsion against the psychic reality of the other. To know what determines not only the quality of the relationship that the patient has with their therapist, but also the relationship that the therapist is able to manage in respect of the patient is an essential element to understand the psychotherapeutic process and its outcome. Therefore, the principal objective of this work is to show how the theoretical definition of the death instinct as the annulment pulsion against the human reality of the other, can shed light on outstanding questions regarding psychotherapy research. Between them, the question of the responsiveness and the flexibility, which are aspects strictly linked in literature to the question of the effective therapist (Constantino, Boswell & Coyne, 2021). In literature, the most important achievement regarding this topic of research has been the effort to identify the characteristics or the actions of “the effective therapist “, but remaining at a level of investigation which does not consider the non conscious relationship between therapist and patient. The research regarding countertransference, even considering its current pan-theoretical meaning, has not historically gone beyond the possibility that in the relationship with the patient, the therapist’s internal and external reactions, exclusively due to unsolved internal conflicts, could be implicated. Therefore, the original knowledge introduced by Death instinct and knowledge sheds light on the crucial problem underlying the non- responsiveness, with important implications regarding the training of the future psychotherapists, as well as the intervention on mental health.
References
- Fagioli, M. (1971). Istinto di morte e conoscenza (14th). Roma: L’Asino d’oro.
- Constantino, M.J., Boswell, J.F. & Coyne, A.E. ( 2021). Patient, Therapist, and Relational Factors.In M. Barkham, W. Lutz & L.C. Castonguay (Ed.). Handbook of Psychotherapy and Behavior change (225-262). Hoboken (NJ): Wiley
- Kiesler, D.J. (1966). Some myths of psychotherapy research and the search for a paradigm. Psychological Bullettin, 65 (2), 110-136.
- Wampold, B.E., Owen, J. (2021). Therapist Effects: History, Methods, Magnitude, and Characteristics of Effective Therapist. In M. Barkham, W. Lutz & L.C. Castonguay ( Ed.), Handbook of Psychotherapy and Behavior change ( p.297-326). Hoboken ( NJ): Wiley
