Analytic Asymmetries and their Discontents

The analytic setting is replete with relational asymmetries between patient and therapist. Historically, the very terms of its inception, late in the nineteenth century, predicate analysis on the patient-doctor metaphor. One is diseased, the other healthy; one is knowledgeable in the relevant respects, the other ignorant; one is potent, the other weak and help-seeking. The analytic setting had sufficient vitality in its social context to allow it to spread and develop, but its asymmetric aspect proved problematic from early on. Initial objections came primarily from patients who resented the imposition of authority on matters in which they felt no less informed: their own lives. Patients' objections were often swept aside by resistance interpretations (Freud, 1914), which acted, partly, to neutralize the patients' insights regarding the analytic process and the analyst's person. But continuing examination of the notion of resistance brought out the paradoxical nature of the analytic situation: it purports to conduct intimacy, which so strongly arouses the need for mutuality, within a framework predicated on asymmetry (Friedman, 1988).

Democratic social sensibilities, alongside the wish to improve the efficacy of therapy, soon drove analysts to take more symmetrical views on the practice of their vocation. Early on, Ferenczi introduced a far-reaching alternative in the form of mutual analysis (Wolstein, 1992); Winnicott (1965) shifted the emphasis on the role of interpretation from insight to play (a distinctly symmetrical engagement); interpersonalists stressed the analyst's involvement (Greenberg and Mitchell, 1983) and poststructuralists engaged in a systematic dethroning of authority in analysis (Barratt, 1993). The original clarity of the asymmetrical statement cracked, and increasing degrees of mutuality were accepted into analytic definitions and practices (Mitchell, 1993). However, asymmetry remained a vital component of the therapeutic frame and forced its wa