Finding our analytic way

As TBIPS concludes its academic year, candidates continue to grapple with what are the therapeutic aims of treatment and what brings about change. This grappling is a never ending negotiation between therapist and patient, and therapist with her/his own professional identity.

Sandy Shapiro [see Sept 12, 2010 post]said that patients will let us know what they need. Sometimes people come with unspoken but profoundly human motivations communicated in the action of relationship. Therapists, relying both on the unique patient’s needs, and a background of understanding of human needs in general, are able to provide experiences which have been heretofore lacking [deficit model] for the patient. E.g., if a patient grew up discounted and ignored, the analytic situation offers an opportunity for a different experience and a reconfiguring of the way a patient sees her/himself in the world.

The biological striving to pass on genetic material for the survival of the species is accompanied by many postulated psychological motivations. Freud’s theory of motivation postulated the discharge of the accumulated energy from instinctual drives. Winnicott saw creativity and play as essential aspects of the true self. Kohut advocated the development and maintenance of a cohesive self. Bach saw as important the integration of a “sense of wholeness and aliveness” which included developing one’s own awareness and subjectivity, as well as learning to see oneself as one among many, with a place in the world. Maroda notes that people, to develop a full interpersonal repertoire as both subject and object, need to have their affective communications responded to, held, and returned in modified form [ala Bion]. Spezzano writes that human beings are motivated to share their conscious selves, regardless of other unconscious motivations, and that we can only know ourselves in light of how others know us.

If people require a sense of agency, including capacity for self and mutual regulation of affective states, and a sense of the subjective self in the context of relatedness and recognition by (and identification with) others as subjects in their own right, then isn’t it helpful to patients for therapists to include in their analytic attitudes the capacity to sometimes regulate dysregulated affect, the articulation of being affected by the subject of the patient, as well as the capacity to play, and an open-hearted acceptance of a patient as s/he is now while also holding in mind the future, changed patient? If a patient was made to feel helpless and hopeless about affecting others, the analytic relationship is a place where the analyst, when moved, does not necessarily keep a blank face or remain silent. If a patient endured trauma in isolation, s/he now has a companion who knows her/his suffering. Each candidate strives to hone her/his personal identity and style while trying to meet each patient’s unique needs. It is a formidable task, and a joyful one.