Click here to read Dr. Stone’s piece.
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Dear Dr. Stone,
I would like to share my thoughts about your interesting article in the Harvard Magazine. I am responding to the following questions you raise.
“The task of constructing self-descriptions in psychoanalytic therapy also encounters the problem of memory. Everything we have learned in recent years about memory has emphasized its plasticity, the ease with which it can be distorted, and the difficulties of reaching a hypothetical veridical memory. Much of what psychoanalysis considered infantile amnesia may be a function of the reorganizing brain rather than of the repressing mind. All of this makes the task of constructing meaningful histories of desire in the individual more daunting.”
“If there is no important connection between childhood events and adult psychopathology, then Freudian theories lose much of their explanatory power. If memory cannot be trusted to construct a self-description, what does one do in therapy?”
“My focus is almost entirely on the here and now, on problem-solving, and on helping patients find new strategies and new ways of interacting with the important people in their lives.”
I am sad that you seem to have lost your conviction about the psychoanalytic method (I am not referring to the couch), but I think you presented important points that psychoanalysts need to think about.
I agree with you that standing on the shoulders of anyone keeps us feeling safe and blinds us at the same time. It blinds us to our own common sense, our own observations, our own esthetic senses, our own personal drummers, our own experiences and most of all it discourages standing on one’s own feet which is the aim of a good psychotherapist. I wonder why this need for safety and even blindness prevails in psychoanalytic work.
I found it particularly refreshing to be reminded that Freud was in fact an artist and a historian. Science may have been more prestigious for him, fighting for acceptance of his work in 19th century Vienna but as you pointed out, he did receive the Goethe prize for his writing. But his insistence that psychoanalysis be considered a science has not helped the field in my opinion.
There has always been a competition between the two pursuits:science and art. The need for order versus expression of instinct and emotion(even with structure) has been an age old dilemma going back to Greek mythology – Apollo and Dionysus. Rarely do the two combine but when they do, great art is the result. And I believe that great scientists have and use artistic ability. From Michelangelo to Picasso to some graffiti and from Palestrina to Bach to Stravinsky to the Beatles and even Snoopp Dogg, art is what makes and keeps us human. Science is leading us to more robots, and I think it is our fear of feeling emotion, both loving and hateful, that leads us to embrace a world of automatons. We experience vicarious pleasure and even pain too often instead of experiencing it ourselves. But that is not my main point.
In my 30 years of experience, which includes classical institute training, years of advanced study, along with my clinical and supervisory work, I have come to believe that the major requirement in the field of psychoanalytic psychotherapies is the ability to listen. We analysts seem to put a premium on how we help our patients understand their lives by making interpretations and constructions, often based on one theory or another. But, most often, our narcissistic need to cure involves too much activity. For instance, the insistence on exclusively oedipal interpretation is ruining the profession. I heard from a friend just recently that candidates are being taught to “bring everything into the transference and to interpret it exclusively.” No wonder psychoanalysis frightens patients.
Too often we buy into our patients’ needs to see us as experts. And too often we call ourselves scientific at the expense of recognizing the humanistic/artistic talents we possess. Our journals are called scientific journals, and the accepted articles must conform to a scientific form. I question this ‘so-called scientific article’ with its long bibliography because each author chooses who to cite and who to ignore. Is that scientific? I think we learn more from reading novels, going to theatre, museums and galleries, and listening to music. The arts open our minds. Listening to a Beethoven string quartet or to the improvisation in jazz trains us to hear patterns – so important in our work.
The received wisdom we inherit, while interesting , impressive, and well meaning, can do two things. First it can blind us to our own observations, skewing them according to the latest theory we admire. Secondly, and more helpfully, these theories can help us keep quiet while the patient tells her story. We need some solid ground beneath our feet during the regressions we witness and undergo ourselves so that we do not fall. Theories of the mind can provide solid ground as long as they assuage our anxiety – because it is the analyst’s anxiety that must be tamed. While theories can help orient us when we are lost, they can also distort our perception. A balance is crucial.
Eventually, with experience, we hopefully find our own voices which help us listen without the props and with deeper and deeper focus. Yes, some theoretical understanding helps us suggest possibilities to the patient – and this is how we illustrate our concern and interest. But we also use our associations to books, movies and even pop songs. The aim of listening is to connect. Each patient responds uniquely to our efforts. Robert Glick (personal communication) suggests a Detective Colombo (Peter Falk) approach which allows the patient to present evidence in her ongoing mystery.
My conviction rests on listening with as open a mind as possible. I see both inside and outside of the office how people need to be heard. Even now, I am expressing my own need to be heard. Writing is easier than talking because no one interrupts. But luckily we have these forums or list-serves with people interacting. The need to interact respectfully is a basic one – to be valued at all costs. Your paper inspired me to think and this chance to agree or disagree can start a communication.
Finally, you remind us of what our our critics say:
“developmental events have no important causative relationship to the phenomena of psychopathology, and second, that the self-descriptions generated by our explanatory theories are both irrelevant and unverifiable.”
You go on to recommend that we focus on the here and now relationship. My question is how can the here and now connection not be influenced by the perceived past? I have continually found that when a patient understands that what she feels or does in her life has roots she feels way less self-punitive.
Here is a perfect opening to respect our common sense or even our understanding of history and to let out patients see possible connections. The phrase ‘history repeats itself’ is true. Having listened to a person’s story – however colored by memory and perception, we cannot help but see the way that the past is relived albeit in unique and disguised ways. Most, if not all of my patients have grown up with sustained trauma. Early loss of a parent, early illness, abandonment (real or perceived,) parents who were overstimulating or absent, punitive or dismissive or too adoring – all these situations and others effect each child differently according to innate disposition, diet, comfort, poverty, etc. and effect the ability to connect with another. Shengold has written movingly about the patience required in treating such patients. It is the therapist’s ability to connect with her patients over time that has a healing potential. Not a cure by any means – but an alleviation of the pain of loneliness which leads to different degrees of freedom and new choices.
You may say that connection is to be found with friends and family. But when relationships are fraught with difficulty as they often are with our patients, it is the analyst with her benign curiosity and consistency who can best address the fears involved in trusting – the fears that cause loneliness.
Sincerely,
Jane Hall