Unconscious Learning and Conscious Choice*: Commentary on Levenson's Essay

Describing how she had changed during analysis, a patient said, “my symptoms became much softer because everything else in my life became more important.” She then explained that she always thought analysis would help her to understand her symptoms, which would then go away and free her to engage people she desired but avoided because of paralyzing anxiety. Now she realized that cure may involve a reverse process. As she became more able to show herself, she became less concerned with her symptoms and their meaning. Although she still became anxious in basically the same situations, her anxiety was now mixed with excitement—frequently more stimulating than paralyzing. I associated excitement with love and desire, and told her that, according to an old Spanish saying, fear is the real enemy of love. She associated fear with “being stuck in the same place,” with covering up, and with fear of losing something—she could not say what. She added that her fear made her look down on herself and hide from those she cared most about, and that she was always trying to control her anxiety in their presence. The way she said “presence” reminded me of how easily she lay on the couch from the start of her treatment. I wondered aloud whether she thought that I would look down on her if she showed me her anxiety, instead of just telling me about it. She responded by moving from the couch to the chair, with a smile that seemed both hopeful and uncertain. I felt as trusted as I felt challenged, and thought that she had developed enough trust in herself and me to challenge both of us. My patient's move placed us face to face and at eye level, a position in which, she unknowingly agreed with Freud, it is difficult for one to hide.

This brief clinical vignette resonates with central and lingering questions