Thursday, October 21, 2010

Meeting the Continual Challenges... by E. Vazques

Meeting the continual challenges…

We in the Tampa Bay area are all very fortunate to have a number of remarkable ongoing educational opportunities – see the Tampa Bay Institute for Psychoanalytic Studies, Inc’s educational program for trainees for this year, posted on this blog, the Tampa Bay Psychoanalytic Society, Inc’s excellent 2010-2011 Speakers Series and its, along with the USF Humanities Institute 2010-11 Film Series (a report from which was just posted on this blog).

I am very grateful to our colleagues who took the trouble and made the effort to put all this together for I cannot think of a better way to help us meet the continual challenges we face as contemporary clinicians – “our everyday struggle to understand and heal by way of the ‘talking cure’; the conflicts between old and new ideas in psychoanalytic theory and practice; the challenge of developmental thinking; the need to recognize our work as situated historically, culturally, and politically; the pervasiveness of cognitive neuroscience, of ‘evidence-based’ treatments like cognitive-behavioral approaches, biological/pharmacological reductionism, and many more“ (Orange, 2010).

Sometimes one can experience these challenges as daunting, as in these lines (my free translation) from Spanish poet Antonio Machado (1917): “Traveler, your footprints
are the road, and nothing more;
you make the path as you walk…
Traveler there is no road,
only wind-grooves on the shoals.”

Fortunately, Orange (2010), contends that “[t]houghtful psychoanalysts and other humanistic clinician are practicing philosophers.” For whom “Socrates remains the dominant ideal for Western philosophy. Simple-living, ever-questioning, relentlessly seeking the good human life…”
As clinicians our personal and professional ideals resemble those of Socrates; we “long to understand, but know how little we know. We are always questioning our assumptions, our reactions, and the inevitable limitations of our points of view. Our field is human emotional life – in particular the lives of those suffering others (the word PATIENT coming from the Latin PARTIOR, meaning to suffer) who come to us full of hope and dread (Mitchell, 1993): hope that a human connection may save them, and dread that it may fail them once more.” She suggests, moreover, that a “hermeneutic sensibility,” a “hermeneutic attitude,” makes our clinical work possible, and that such hermeneutic clinical sensibility includes:
“a) a strong sense of one’s own situation – including one’s theories, personal history, and personality organization –
that constantly and inevitably shapes and limits both one’s actual understanding and one’s capacity to understand
a particular patient;
b) a sense of experiential world or system, one’s own, the patient’s, and that formed with the patient;
c) a strong sense of complexity that resists all forms of reductionism and technical rationality [that is, technique]
in clinical work;
d) a sensitivity to the languages of personal experience, including their nonverbal backgrounds and forms of expression;
e) a strong developmental-historical [and, I would add cultural] sense that gives, overall, equal emphasis to past and future,
one that attends to processes of emergence, including emergence of defense and dissociation, throughout the clinical process;
f) a belief that understanding is effective, that is, that understanding in the rich sense is curative;
g) a conviction that dialogue and conversation are the best way to create and register that emotional resonance indispensable
to meaning-oriented work; and
h) a sense of vocation and devotion similar to Friedrich Schleiermacher’s “rigorous practice.” For Schleiermacher,
“misunderstanding occurs as a matter of course, and so understanding must be willed and sought at every point”
(Schleiermacher, 1998:110).”

Ernesto Vasquez, MD
October 21, 2010

Orange, D. (2010). Thinking for Clinicians. Philosophical Resources for Contemporary Psychoanalysis and the Humanistic Psychotherapies.
New York: Routledge.
Machado, A. (1917). Poesias Completas. Madrid: Residencia de Estudiantes.

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