Psychoanalytic Listening: Methods, Limits, and Innovations

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Through all this and more, both silence and verbalisation become integral to our clinical enterprise. The discussion of silence leads me to the next logical stopping point, that is, all that is communicated by the patient in the form of action. This forms the topic of the next chapter of this book.

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I divide my dis- course into listening to actions i while arranging the first visit, ii as the patient arrives for the first visit, iii during this initial consultation, iv during the beginning phase of analysis, v during the middle phase of analysis, and vi during the termination phase of analysis. Consider- ing them as messages about his psychopathological state and—later, in the course of the treatment—about his transference relatedness, I tackle the thorny issue of interpreting these behavioural aspects during our clinical work. I review the broad and evolving concept of countertransference, under the rubric of which the experi- ences I describe tend to belong.

I extend this idea in useful directions by utilising a synthesis of the ego-psychological, object relations, and the au courant relational and intersubjective vantage points. The same conceptual scaffold deepens our understanding of how our capacity for analytic listening gets seri- ously compromised. This constitutes the topic of my next chapter. Many of these variables can exist simultaneously and one variable e. Some factors e. One must nonetheless be aware of their potentially deleterious impact upon analytic listening.

I attempt to make such impact vivid and convincing by bringing forth corroborative evidence from earlier literature and by offering sugges- tive clinical vignettes from my practice. In the next chapter, I note that speech itself can serve as a resistance to the analytic process. However, refusal to listen is a technical strategy that i should be utilised only by those with considerable clinical experience, ii should be used spar- ingly, iii should be used after much affirmative and interpretive work has been done, iv should be made after consultation with a colleague, and, if that is not possible, its use must be discussed post-hoc with a colleague, v should be used after an earnest effort has been made to disentangle countertransference temptations from genuine therapeutic intent, and vi requires that its impact upon the patient be looked for and analytically handled.

Also to be underscored is that even when the analyst refuses to listen, the analyst actually does not stop listening.

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What he does is stop listening to surface material and start insisting that the patient go deeper. Having elucidated all these aspects of analytic listening, I attempt to demonstrate the restrictions we must put on this prized capacity of ours. In the final chapter of the book, I describe how psychoanalytic lis- tening needs to be tempered in the following three situations: i during supervision, ii in public discourse, and iii at home.

Such restraints on the use of our analytic minds paradoxically sharpen their edge. Their layering of history, their coverage of literature, their anchor in theory, their provision of clinical vignettes, and their intricate relationships with each other yield a multifaceted and nuanced discourse on the topic of analytic listening.

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It is my sincere hope that such effort and integrative striving would help prospective and novice analysts in fine-tuning their listening capacities. If those who are truly experienced in our field, too, find something of meaning here, I would be happier. I n his papers on psychoanalytic technique, Freud e, b, e, c, g, a dealt with almost all important aspects of our clinical enterprise, including the need for a certain frequency and regularity of sessions, payment, use of the couch, free association, the limits of memory and recall, resistance, transference, anonymity and neutrality, working with dreams, and interpretive interventions of the analyst.

Note the following recommendations made by Freud in this context. It also included paying attention to his silences, and to the non-verbal cues he offered Freud, d, g, There was no scope for focusing, choosing, or cen- soring here. In a later paper, Freud reiterated that. We gather the material for our work from a variety of sources— from what is conveyed to us by the information given us by the patient and by his free associations, from what he shows us in his transferences, from what we arrive at by interpreting his dreams, and from what he betrays by his slips or parapraxes.

All this mate- rial helps us to make constructions about what happened to him and has been forgotten as well as what is happening in him now without his understanding it. Moreover, the various ways of listening that have evolved are not surgically apart; they show significant overlaps. These include i objective listening, ii subjective listening, iii empathic listening, and iv intersubjective listening. Each perspective deserves separate consideration though without overlooking its complementarity and confluence with its counterparts.

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Extrapolated to psychoanalysis,. The ethic is stoic: maturity and mental health depend on the extent to which a person can acknowledge reality as it is and be rational and wise. Strenger, , p. Attention is paid to what the patient is talking about but greater interest remains in how the patient is talking; the process is accorded more value than the content.

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It pays sharp attention to a pause, an abrupt change of topic, the emergence of an incongruent affect, and an unexplained avoidance of the logically expectable. Busch , has further elaborated upon this manner of working with patients. However, they tend to regard all free associations as referring to trans- ference Hinshelwood, ; Klein, ; Riviere, This is because the Kleinians regard free associations themselves as actions. Less dramatic and far more systematically presented are the views of Jacobs , , , More than any other analyst—perhaps with the exception of Searles , who largely dealt with severely ill and often psychotic patients—Jacobs relies upon his inner emotional state, his passing associations, his rev- erie, and even his attire and postural changes to discern the events that are taking place between him and his patient but are just so slightly out of the conscious awareness of both.

He notes that:. The manner in which the analyst begins and ends a session; his posture, facial expressions and tone as he greets or says goodbye to his patient, convey kinesic messages of which he may or may not be himself be cognizant …. At other times, the patient may detect from the slightest acoustical clues an otherwise unexpressed attitude or feeling on the part of the analyst. By paying attention to his own posture, gestures, and move- ment, the analyst gains deeper knowledge of the patient see Chapter Four for more details.

Jacobs wonders if work with physically trau- matised patients is more often associated with somatic resonances in the analyst. He also allows for individual variations within analysts themselves. In some analysts who have had significant experiences of bodily illness or trauma, or who perhaps for other reasons of an innate or experiential kind have a highly cathected body ego, there may be an increased capacity to utilize bodily responses in their analytic work.

This refers to. Assembled in, and existing only, during the analytic hour, it might concretely be imagined as a brain containing two halves. One half belongs to the patient, the other half to the analyst. In the analytic session as both ana- lyst and patient loosen their ties to the external world and enter into a slightly altered state of consciousness—essentially a condi- tion of daydreaming—these two halves come together in a tempo- rary union, a bridge is built, and unconscious messages can flow between them. This is a process that begins in early infancy and consists of parts of the rudimentary self being split off and projected into an external object.

The latter then becomes identified with the repudiated part as well as internally controlled by it. While starting out as a developmental proc- ess parallel to introjection, projective identification can come to serve many defensive purposes. These include attempted fusion with exter- nal objects to avoid the existential burden of separateness, extrusion of bad internal objects that cause persecutory anxieties, and preservation of endangered good aspects of the self by depositing them into others.

The frequent development of violently nega- tive countertransference while working with borderline patients has been elucidated by Kernberg , , in great detail; he has also described the technical strategies consequent upon such feelings. Individuals with other severe personality disorders also tend to use this defence mechanism. And its impact shows up in the turbulent subjectivity of the treating clinician. The analyst working with a narcissistic patient, for instance, experiences feelings of inferior- ity and even shame about his clothes, office, language skills, knowledge of world affairs, etc.

Psychoanalytic Listening: Methods, Limits, and Innovations by Salman Akhtar

Ibid, p. Greenson , another major contributor to the empathic perspec- tive on analytic listening, added further nuances to the topic. Listen- ing alone is not enough, he says.

The analyst must possess the ability for controlled and reversible regressions in his ego functions see also Nichols, Whether empathic listening—as opposed to, say, objective listen- ing—can more rapidly yield meaningful information about the patient is also addressed by Greenson.

Empathy and intuition are related. Both are special methods of gaining quick and deep understanding.

One empathizes to reach feelings; one uses intuition to get ideas. Empathy is to affects and impulses what intuition is to thinking. Empathy often leads to intu- ition. You arrive at the feelings and pictures via empathy, but intuition sets off the signal in the analytic ego that you have hit it.

Intuition picks up the clues that empathy gathers. Empathy is essentially a function of the experiencing ego, whereas intuition comes from the analyzing ego. While showing great interest in the empathic perspective, Greenson largely maintained an eclectic approach towards analytic listening, moving deftly between various forms of listening though without explicitly registering such latitude. In contrast, Heinz Kohut and Eve- lyne Schwaber made the empathic form of listening the centrepiece of their approach.

Development aims at a self which consists of a continuous flow from ambitions to ideas, from a sense of vitality towards goals which are experienced as intrinsically valuable. The ethic is romantic: maturity and mental health consist in the ability to sustain enthusiasm and a sense of meaning. His language also changed. The grandiose self, idealised parent imago, narcissistic transferences, and transmuting internalisation Kohut, gave way to nuclear goals, nuclear ambitions, selective inclusion, and self-object phenomena Kohut, All this had a clear impact on the listening perspective he came to embrace.

In contributions spanning three decades Schwaber, , , , , , , she has championed the cause of empathic listening. Taking the monumental shift, in early psy- choanalysis from seduction theory to fantasy-based neurosogenesis as her starting point, Schwaber laments that the listening perspective of many analysts has not undergone a corresponding change. In contrast, Schwaber proposes a:.