Toward the Analysis of Microstructure

In her Final Lectures on technical considerations, Karen Horney explicitly affirmed the crucial place of the psychoanalyst's attention. It was Horney's conviction, one generally shared in the psychoanalytic community, that attention to patient productions as well as to the analyst's own associations, including his feelings, impulses, thoughts, theoretical speculations, literary allusions, memories, and so forth, properly serves to enrich the analyst's understanding of the patient and the transaction. Yet what phenomenologically occurs in the attentive analyst's mind is beyond the reach of training analyses, supervised controls, and even subsequent self-analytic reflection by the clinician. Though certainly valuable, these are at best careful reports or surmises, recollections already edited and elaborated.

What occurs, I venture, are responses that remain largely inchoate, associations and feelings that although conscious enough, are rarely played through, each one following so quickly after the one before that instead, as the patient flies along in his own productions so the analyst's own associations and feelings follow likewise. The separate data of patient manifest content and the analyst's own empathic responsiveness coalesce and flow without regard to whether the analyst might care to pause and reflect as he might desire. Rather than study the separate notes, however instructive that may be to understanding underlying structure of the music, the analyst more likely appreciates that structure by simply listening to the aesthetic of the music and catching what he can from time to time.

Only occasionally can the analyst pause long enough to consider in detail a slip, an omission, some unanticipated emphasis of word or gesture, a stammer, a sudden change in the direction of a sentence, the possible interplay of a patient's defensive system, some particular reaction of his own, plausible speculations on what seems to be a transference manifestation, etc. What