Consultation from the Position of the Third

The psychotherapy dyad at the Austen Riggs Center is embedded in a complex, hierarchically organized set of patient and staff roles functioning in a therapeutic community whose examined living includes the behavior of staff as well as patients.

In maintaining such a reflective milieu we try to follow basic psychoanalytic principles: that behavior always has consequences for meaning and its interpretation. Behavior is taken as signifying something other than its overt motion, and, except for a very short list of behaviors incompatible with an open setting, behavior rarely leads to an immediate administrative response. We believe behavior is motivated by and is intended to communicate meaning: Behavior is a sign of often unconscious processes of love and hate, seduction and retaliation, an invitation to affirm a boundary while transgressing it. Our entire system works at interpreting behavior, because in themselves actions are mute and depend on us to give voice to their significance.

In our open setting all behavior is public. That is, in our community of examined living there is no such thing as private behavior. Most of our actions are not worth interpreting, of course, but all that occurs in the community is potentially interpretable. A patient cannot claim protection from scrutiny by saying that self-mutilation occurred privately in one's room. Such behavior must be interpreted. In deciding what gets interpreted, we take into account courtesy, respect, exigency, and those forms of assault on the treatment that the patient disavows.

In the open setting, what is private is the patient's speech—speech not just with a therapist, but with a friend, on the telephone, with consultants. When an impasse occurs in psychotherapy, the therapist, patient, and director of patient care explicitly decide to waive the privacy of speech by inviting a third party, a senior staff member, to share in it. Such a sharing