Monday, January 3, 2011

An Analytic Attitude

As I come off a three week break from facilitating classes at the Tampa Bay Institute for Psychoanalytic Studies, Inc., I think again about how experienced psychoanalytic clinicians might share an analytic attitude with students, avid to experience a deeper relationship and understanding with those who seek them out for help. While an analytic attitude comes with inclination and experience, fostered by training and our own analyses, and while there is no agreement on theory, analysts share the common attitude of endeavoring to understand the intrapsychic and interpersonal life of the patient, to hold the needs of the patient within a frame, and to foster the growth and development of the patient toward a more meaningful and enriched, diverse life. We behave ethically. We behave with restraint. We work to be aware of the influence we have on patients by being self-reflective. We bear, sometimes with our patients, sometimes alone, unbearable affects, tensions, paradox, and uncertainty.

Perhaps I would benefit most from a New Year's resolution to give up control, to 'let go.' Most people, including therapists, particularly those with medical training, have the urge to assert control and avoid vulnerabilities and insufficiencies. Giving up the illusion of control, however scary, and being open to the experience of therapy and its co-creativity, allows transformative possibilities, and leads us and our patients away from self-alienation. Control does not constitute nor uplift the self.

A psychoanalytic attitude is the openness to experience the emotional ‘truth’ of the other’s, as well as our own, subjectivity. It is an ardent experiencing, appreciating experience in its own right, alongside insight, toward the true self; to value not only knowing but being toward the true self. This philosophical attitude decenters insight’s privileged place and makes room for relationship and for being with. Decreasing the patient’s isolation can lessen suffering. Psychotherapy is a sacred experience, under-taken, like faith, with one’s whole being, giving oneself over to the possibility of being in communion, if only rarely and momentarily, with another. Each member of the dyad ideally participates with openness and intensity as we make meaning of ourselves and our lives through revelation and through impact on each other.

Bion advocated an openness to the patient within the bounds of our ethics, always mustering up our respect, decency, and wisdom. When analyzing, open inquiry is preferable to knowledge. Bion advised that we approach each session ‘without memory or desire,’ that we be open to the new possibilities co-created when the therapist does not insist on knowing or on helping, but instead leaves space for a path that is always evolving, unpredictable and unique. When we, with an open heart, do not expect patients to give up their troubles, another serendipitous effect may include the lessening of those very symptoms.

I ask myself, "Can I recognize without flinching another’s subjectivity, or, when I inevitably flinch, can I acknowledge with the patient my discomfort in a way that negotiates a new closeness with, and understanding of, the patient? Can I model that there is no thing too untenable to hear, or to bear feeling, in the company of another? Can I survive the untenable without retaliation (withdrawal, humiliation, breaches of empathy) and hold in tension (not ‘either/or’ but ‘both’) uncertainty with knowing?"

Lycia Alexander-Guerra, MD

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