Long before any theoretical contributions from various schools of psychoanalysis are introduced to first year candidates at the Tampa Bay Institute for Psychoanalytic Studies, the majority of the first year course, Introduction to Psychoanalytic Concepts I, discusses with candidates how to be with patients. How fortuitous that I have recently come across the immensely readable (and highly autobiographical) primer by Louis Breger, Psychotherapy Lives Intersecting (2012; Transaction Publishers, New Brunswick, NJ) which adds the perspective of former patients, what they found helpful and unhelpful in their treatments, to the pearls gleaned from his vast experience as a psychoanalyst. Breger aims his book at people considering therapy, but therapists, too, will greatly benefit from this jargon free exposition. What is unique about this book is that the many clinical vignettes are enriched by reflections from patients about their own psychoanalytic journeys, something the reader may find courageous.
Elizabeth (pp. ix) writes, 'Throughout the therapy experience with you, I always felt like a person in a relationship, rather than a person to be understood by you, and then explained back to me…you communicated an utter lack of judgment, an acceptance of the aspects of my life about which I was most embarrassed, and modeled that Not Knowing was okay'. Another patient, Bernie, (pp. 29) “singles out catharsis, having a safe person to talk with, and insights-in that order-as the helpful factors of his therapy.” Breger says of his own analysis, “…it was the relationship itself—being accepted, listened to in a noncritical manner, understood, appreciated, even liked—after revealing what I felt were my most shameful and guilt-ridden secrets—that was most helpful." Breger listened closely, was not dogmatic, and did not dictate rules.
Just as research shows that the person of the analyst is more important than her/his theoretical orientation, Breger recognizes that relationship is as important, maybe more so, as interpretation and insight. Breger also sees the benefit of ‘fit’ between analyst and analysand, including whether the therapist likes and identifies with the patient. Instead of illustrating how to behave as an analyst, Breger writes about an analytic attitude. Breger muses on anonymity, authenticity (about being human), self disclosure (must [also] be for the benefit of the patient), and analyzability. But Psychotherapy Lives Intersecting is as much about Breger’s personal journey as an analyst as it is about how his patients viewed their treatment. The neophyte will benefit greatly from this disclosure. His “straightforward approach” to writing and to his patients is refreshing. As a traditionally trained analyst who also found a relational home in contemporary theories, I found it wonderful to immerse myself in a book where I found like mindedness.
Wednesday, May 30, 2012
Posted by Lycia Alexander-Guerra, M.D. at 7:24 AM