Friday, March 4, 2011

Subjectivity, self-disclosure, and an ideal

It is now well articulated that our own subjectivity greatly influences, both explicitly and implicitly, the work co-created by us and our patients. Whereas Freud thought abstinence, neutrality, and anonymity were part of the ideal stance, contemporary thinkers know these to be not only impossible but sometimes unhelpful, even detrimental, to the therapeutic process. Aron (1991), and Hoffman(1983) write that the patient's experience of the analyst's subjectivity needs to be made conscious, that is, it is sometimes okay to ask patients what they notice about us and our reactions, perhaps particularly when we have feelings we hope we have kept hidden from the patient. Patient reaction to our subjectivity is only one aspect of the transference, but was, traditionally, a neglected area of exploration. (Remember that what patients notice about us may also be defended against by patients.) Just as patients can not entirely know themselves, neither are we the authority on the accuracy of our patients' perceptions of us. Patients learn about themselves from us, so we, too, learn, often uncomfortably, about ourselves from patients. Bion thought that the more real the analyst, the more the analyst can be in tune with the patient’s reality.

Still we strive to be careful not to impinge on the psychoanalytic process by excessive self-revelation. I like to think that self disclosure pertains to allowing into the process what is going on with me in the therapeutic relationship, not about what goes on with me in my private life. Semrad quipped that psychotherapy is a mess trying to help a bigger mess, his way, I think, of saying that you do not have to be a perfect person to be a good therapist. Because self-revelation by the therapist is ongoing and inevitable, we (through our deportment, dress, attitude, etc) cannot help but to reveal our imperfections. They may impinge upon the patient less when we find in our personal lives gratification in love, work, and play, separate from what gratification we un/consciously hope for from patients.

When considering our own subjectivity (point of view, beliefs, opinions, goals, desires, etc.), we might examine our own motivations for having chosen the mental health profession as well as our fantasies about how we might help others, and ourselves, by having so chosen. Philosophically, do we have hope for ourselves (and do we hope to facilitate hope in others) for a life experienced with fullness and passion, for both joys and sorrows, and to experience life, not in isolation, but in authentic connection with others? Is ardor for life a personal value? An ideal stance then might better be suited by being open and curious, and brave toward newness, uncertainty, and psychological intimacy.

Aron, L. (1991). The Patient's Experience of the Analyst's Subjectivity. Psychoanal. Dial., 1:29-51
Hoffman, I.Z. (1983). The Patient as Interpreter of the Analyst's Experience. Contemp. Psychoanal., 19:389-422.

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