There used to be a name for this kind of problem: chicken or the egg? But dinosaurs laid eggs. So that one is solved. Now I asked the eminent psychoanalyst Sheldon Bach the art or science question. He said, “When I was young, I was a scientist, now I think I am more of an artist.” This was a little like the chicken saying, “When I was young, I was an egg, now I am a chicken.” One way of understanding this is that science is the activity of exploring the unknown while art is the communication of feelings that the artist did not know she had until she created the work of art. Without this connection to the previously unknown, the work becomes polemics decorated with beauty. The mysterious process of finding something new by communicating it is what we call art.
In other words, at the beginning of a career as a psychoanalyst, there is a great deal to be learned and learning it makes a person able to use the knowledge to communicate with patients. This learning something new is the method of science. So, the young analyst is thinking like a scientist. And the key new things for the young analyst to learn are what the patient is feeling and what the patient is thinking. Knowing how to think like a patient enables an analyst to create a dialogue that can be felt as an empathic interchange. Feeling becomes thought when the analyst inquires about it, prompting the patient to think about her own feelings and to try to put the feelings into words. The patient becomes the scientist in searching for new knowledge about her own feelings. Finding out about feelings is science; communicating them is art. In psychoanalysis, art and science are indissoluble, discovery is made in the act of communicating. Lest this sound too abstract, here is a clinical example.
A patient in the later stages of analysis said to me recently: “When you gave me that interpretation about why I gamble, I knew you were against it. So, I stopped telling you about it.” I recalled the interpretation as my having made a connection between his adolescent superman fantasies and the wish to hit the jackpot. I had said both were ways to succeed without doing hard work. I thought I was being empathic. He heard my
comment as disapproval. I thought I was speaking to how hard he has had to work to get to where he is in life and how uncertain he had been as an adolescent about whether he had what it took to become as successful as he wanted to be and has been.
I connected this to his experience by saying: “Now I have an even worse interpretation to give you. I think the gambling has a connection to your parents' religious faith. They believe they will have everything and be totally happy after they die. They will hit the jackpot.”
I believed that the second interpretation was the result of my knowing that the first one had caused him pain and that by acknowledging that, by calling the second interpretation “even worse,” I was shielding him from the worst of the injury caused by the first one. That was an artistic use of scientific knowledge. I had long ago discovered that prefacing an interpretation with an acknowledgment of how wrong, limited, and/or inaccurate it probably was gave the patient room to experience rejecting what was too soon or too painful. The immediate rejection could be spoken aloud after I had already welcomed it into the discourse. And welcoming it into the discourse gave the patient the power to think further about it without having to accept my “superior wisdom.”
So, what I did know helped me to explore what I did not yet know. Specifically, I did not know whether the fantasy of winning the lottery was derived from his parents' religious beliefs. I did not understand what fed his compulsion. I had a hypothesis and his response to that hypothesis would lead us further into understanding it. The hope was that understanding it would free him from the compulsion to act it out.
From previous analyses I understood that gambling is an attempt to ward off death. Because death has no odds, all living things are destined to die from the moment of conception, there are no odds. Yet figuring out the odds for other events, like which horse will win the race, gives the gambler a sense of control over the future that cannot be attained over death. Another patient who had been orphaned at an early age taught me that. And one whose parents had been in a death camp confirmed it. His parents rejected the religion that had failed their families in the camp, but became people who played cards with their friends every weekend evening. Although they gambled for tiny stakes, they became
passionate about it, surrounded it with special foods they served during the games, left their children home alone or with a teenage baby-sitter evening after evening, and even went to gamble when they were ill or exhausted. While his parents were out the little boy had the fantasy that they would die in a car crash and never come home. He stayed up until they returned, unable to sleep until he was sure they would return.
All of this experience fed my feelings about my then current patient's gambling and about how he could understand its relation to his own childhood fears. I felt scared of going too fast and getting it wrong. As the analyst, what I was feeling I called the counter-transference. I understood my fear as a clue to his feeling. I hypothesized that he was feeling fear. Giving up belief in a protective god entailed an existential fear. If there was no god to protect him, only fortune or Lady Luck could do it. And what motivated me to treat him was a wish to protect him from losing both his money and the time he could otherwise be spending with family and/or friends.
Counter-transference was a tool I had learned to use from reading Racker (2018)* when I wondered what I could do with erotic feelings towards one of my patients early in my practice. Racker helped me to understand that I could be feeling what my patient was feeling. Or I could be feeling the complement of what my patient was feeling or I could be feeling an alternation between the two. Maybe Racker's neatly bifurcated theory might more clinically be seen as an alternation of the two. If we take Racker's work as an example of a psychoanalytic clinical theory, the use I put it to was an example of the artful use of theory by an experienced clinician. This was, I think, an example of Bach's comment. I think, as well, that scientific theory is useful to the beginning clinician and helps support the work as the clinician develops her art and that it becomes less necessary as she gains experience and confidence.
* Originally published in 1968, it was something I read early in my analytic training.