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Psychoanalytic Listening

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'Joseph Breuer's celebrated patient, Anna O., designated psychoanalysis to be a "talking cure". She was correct insofar as psychoanalysis does place verbal exchange at the center stage. However, the focus upon the patient's and therapist's speaking activities diverted attention from how the two parties listen to each other. Psychoanalysis is a listening and talking cure. Both elements are integral to clinical work. Listening with no talking can only go so far. Talking without listening can mislead and harm. And yet, the listening end of the equation has received short shrift in analytic literature.This book aims to rectify this problem by focusing upon analytic listening. Taking Freud's early description of how an analyst ought to listen as its starting point, the book traverses considerable historical, theoretical, and clinical territory. The ground covered ranges from diverse methods of listening through the informative potential of the countertransference to the outer limits of our customary attitude where psychoanalytic listening no longer helps and might even be contraindicated.'- Salmon Akhtar, from his Introduction

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CHAPTER ONE. Four kinds of analytic listening

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“[The analyst] must turn his own unconscious like a receptive organ towards the transmitting unconscious of the patient”

—Sigmund Freud (1912e, p. 115)

In his papers on psychoanalytic technique, Freud (1911e, 1912b, 1912e, 1913c, 1914g, 1915a) dealt with almost all important aspects of our clinical enterprise, including the need for a certain frequency and regularity of sessions, payment, use of the couch, free association, the limits of memory and recall, resistance, transference, anonymity and neutrality, working with dreams, and interpretive interventions of the analyst. He also made a number of remarks about the analyst’s manner of listening and what exactly it is that he ought to be attuned towards in his attention. Note the following recommendations made by Freud in this context.

•   “The technique … is a very simple one … It consists simply in not directing one’s notice to anything in particular and in maintaining the same ‘evenly suspended attention’ in the face of all that one hears” (1912e, pp. 111-112).

 

CHAPTER TWO. Listening to silence

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“No mortal can keep a secret. If his lips are silent, he chatters with his fingertips; betrayal oozes out of him at every pore”

—Sigmund Freud (1905e, p. 71)

Silence is ubiquitous in human dialogue and is therefore bound to make its appearance in the analytic exchange as well.1 Having consistently attracted the attention of poets and philosophers (both Western and Eastern), silence has proven itself to be a topic of intrigue and a potential key to knowledge. And both intrigue and knowledge matter deeply to psychoanalysis. The relevance of silence to psychoanalysis becomes unmistakably clear when one takes into account that silence between two (or more) human beings can signify a vast range of feelings and psychic configurations. Zeligs notes that silence can convey:

agreement, disagreement, pleasure, displeasure, fear, anger, or tranquility. The silence could be a sign of contentment, mutual understanding, and compassion. Or, it might indicate emptiness and complete lack of affect. Human silence can radiate warmth or cast a chill. At one moment, it may be laudatory and accepting; in the next, it can be cutting and contemptuous. Silence may express poise, smugness, snobbishness, taciturnity, or humility. Silence may mean yes or no. It may be giving or receiving, object-directed or narcissistic. Silence may be the sign of defeat or the mask of mastery. When life-and-death situations are being sweated through, there is little occasion for words. Silence may be discreet or indiscreet. A tactful silence serves to prevent the expression of inappropriate thoughts and feelings. (1961, pp. 8–9)

 

CHAPTER THREE. Listening to actions

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“The patient does not remember anything of what he has forgotten and repressed, but acts it out. He reproduces it not as a memory but as an action.”

—Sigmund Freud (1914g, p. 150)

The preceding chapters have demonstrated that patients’ associations, as well as their silences, are our important allies in unmasking (or reconstructing) the unconscious narratives that contribute to their anachronistic suffering. This background prepares us to address the communicative value of the patients’ behaviour. Let me hasten to add that I am not referring to patients’ actions in their “real” lives. My focus is upon patients’ behaviour within the clinical situation and even more so upon the analyst’s ways of discerning meanings in such behaviour.

Three useful concepts

I base my consideration of these matters on three concepts, namely, “nonverbal communication”, “acting in”, and “enactment”. Representing different eras in the history of psychoanalysis and arising from different traditions within the field, these notions provide the conceptual framework for understanding and interpreting patients’ actions in the clinical situation.

 

CHAPTER FOUR. Listening to oneself

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The doctor’s unconscious is able, from the derivatives of the unconscious which are communicated to him, to reconstruct that unconscious which has determined the patient’s free associations.

—Sigmund Freud (1912e, p. 116)

So far in this book, I have focused upon how the analyst attends to the material offered by the patient (e.g., associations, actions, silences). Now I turn my attention to what, in tandem, goes on within the analyst’s own mind and how an ongoing, careful scrutiny of it deepens the knowledge about the nuances of the clinical process as well as of the patient’s concerns and desires. In customary psychoanalytic terminology, I am referring to the informative potential of the “countertransference” phenomenon. However, our theory has moved far ahead from its early days. The introduction of the concept of “projective identification” (Klein, 1946), the attention to the role of the analyst’s empathy (Fliess, 1942; Greenson, 1960; Kohut, 1977, 1982; Olinick, 1969), and the emergence of intersubjective and relational perspectives (Mitchell, 1988, 1993; Mitchell Aron, 1999; Ogden, 1986, 1994; Stolorow & Atwood, 1978) have challenged the original ideas about countertransference (see below). It is therefore best to begin with a brief clarification of this heuristic shift and only then address the specifics of the analyst’s experience that demand attention.

 

CHAPTER FIVE. Listening poorly

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“We have noticed that no psychoanalyst goes further than his own complexes and internal resistances permit”

—Sigmund Freud (1910d, p. 145)

The analyst’s capacity to listen is not established once and for all; it is not sacrosanct or immune to conflicts and compromises. Forces that lie within the analyst as well as those arising in the context of his clinical interaction can readily disturb it. Minor fluctuations in the extent and quality of attunement are frequent and perhaps inevitable; state-related conditions in the analyst (e.g., fatigue, overwork) and impingements of external reality (e.g., loud conversations just outside the office, the building’s fire alarm being set off) are often the culprits. The resultant disturbances in listening do affect the analytic work but the problems arising from them are generally transient and correct-ible. Consequently these do not form the topic of my discourse which focuses upon factors that lead to sustained compromise of the analyst’s listening capacity.

 

CHAPTER SIX. Refusing to listen

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“Psychoanalysis is justly suspicious. One of its rules is that whatever interrupts the progress of analytic work is a resistance.”

—Sigmund Freud (1900a, p. 517)

Spring 1978. I am a junior faculty member in the Department of Psychiatry of the University of Virginia’s School of Medicine. I am considering psychoanalytic training and want to apply to an analytic institute. But I am hesitant. Real and imagined burdens of time and money are not what bother me. I am fearful of rejection, entertaining all sorts of scenarios in which the institute will refuse me entry. Feeling stuck, I seek the counsel of Dan Josephthal, who is a supervisor of mine. He is a warm man with a radiant smile and a twinkle in his eyes. He is solidly grounded in reality and unpretentious. There is also a matter-of-fact sort of tenderness about him. In short, he is a mensch.

We arrive at an Italian restaurant near his office the next day. After we have placed our orders and exchanged a few pleasantries, he looks at me keenly and says, “Tell me why would you not apply for analytic training?” I mumble something to the effect that I fear I might be rejected. He seems puzzled and asks me, “Why?” As I open my mouth to reply, he raises his hand indicating me to stop and says, “I am not interested in listening to those kinds of reasons.” His warmth and friendliness tell me that his shutting me up is not from rudeness. It is actually an act of fatherly tenderness, a nudge to momentarily pull me out of my silly neurotic inhibitions. I get the point he is making. By refusing to listen to (what he rightly anticipated to be) my misplaced self-castigation, he cleaves my ego into an experiencing and an observing section. In effect, he makes an interpretation, telling me that I should not allow my neurotic anxieties to come in the way of my academic growth. Two days later, I mail my application to the psychoanalytic institute.

 

CHAPTER SEVEN. Listening in non-clinical situations

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“For as soon as anyone deliberately concentrates his attention to a certain degree, he begins to select from the material before him; one point will be fixed in his mind with particular clearness and some other will be correspondingly disregarded”

—Sigmund Freud (1912e, p. 112)

Like a cardiologist’s stethoscope or a surgeon’s scalpel, psychoanalytic listening is our prime ally and instrument. We use it, depend upon it, and seek to sharpen it all the time. However, the respect we accord it must go further; it should involve measures to protect the sanctity of this important function. One measure to safeguard the functional astuteness and moral integrity of psychoanalytic listening paradoxically comes from limiting its use. While this statement might appear curious, more strange is the fact that textbooks of psychoanalysis (Moore & Fine, 1995; Nersessian & Kopf, 1996; Person, Cooper & Gabbard, 2005) and monographs on psychoanalytic technique (Etchegoyen, 1999; Fenichel, 1941; Greenson, 1967; Volkan, 2010) make no mention of the limits and bounds of analytic listening. This might be due to their focusing exclusively on the clinical encounter and not upon the analyst’s listening, thinking, and speaking functions in non-clinical situations. The latter are left unaddressed and it is taken for granted that the psychoanalyst would know when to use his analytic mind and when to put it aside. However, many analysts continue to listen and talk in an analytic manner outside the clinical situation. They even take pride in being an analyst “all the time”.

 

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