'Listening'

Living an examined life (Socrates) requires a penchant for a balancing act. In the treatment process, there is always the need to balance orders of experience: the intrapsychic with the interpersonal; the analyst’s subjectivity and experience with the patient’s; the past, present and future; moving toward or away from a closer approximation of the ‘truth’; and so on. Tension needs to be held between dichotomies with an attitude of not ‘either-or’ but ‘both’. While psychoanalysis has traditionally long privileged left brain (explicit, verbal), growing evidence seats the unconscious in the right brain which is emotional-affective, bodily based, relational, and implicit. So another balancing act includes ‘listening’ not only to patients’ words, but to implicit communication.

Right brain information processing is so rapid as to be is non-conscious. It is ultra-rapidly integrative of emotion, affect, facial expression, auditory prosodic, gestural, and other relational data. The right brain is the seat of implicit memory, but interfaces with the left hemisphere, where explicit, verbal communication originates. The brain develops in a way such that self and mutual regulation go on at the non-conscious, implicit level. Schore states that 60% of communication is non-verbal (facial expression, gesture, tone, prosody, pitch, inflection, etc) and recommends that analysis consider affect-laden experience, even dissociated affects. This requires not only understanding language, but understanding implicit process as well.

Freud advocated for the fullest possible acquaintance with the unconscious mind through free association, which presupposes psychic determinism and contiguity, by the patient, and through careful and trained listening by the therapist. Attentive listening is paradoxically balanced with evenly hovering attention and reverie (Ogden), a listening with the third ear. During the evaluative process we let the patient talk freely without too much interruption or direction, but probably ask lots of questions at that time. Subsequent sessions can afford the patient a more direct role in the process while the therapist listens for not merely content but for shifts in the content and affect of the patient; waxing and waning attunement on our own part; shifts in the patient’s and our own self states; initial comments of the hour; developmental issues; character style; relational patterns; transference references; fantasies; etc. Standing in the spaces between so many avenues of inquiry and interest can seem daunting, or meditative, depending on our comfort with uncertainty.