This paper underscores important technical problems that have historically been present in psychoanalysis, and suggests a major technical shift to address them. The proposed new paradigm is summarized as a “give and take” between analyst and patient, a conversation in which the analyst shares personal information (self-discloses) in order to helpfully use the “real” relationship in the room.
The author acknowledges that many current analysts believe the traditional technique he describes has mostly died out. To the degree that practice has now modified technique to be free of the major “traditional” problems, the need for a major further change is less. All improvement is important, however, with the caveat that it does not either discard what remains useful from the past or introduce new problems. This issue is the focus of my commentary.
The “traditional” analyst is described as someone who has “remained under the influence of Freud's theoretical and technical vision of what constituted psychoanalysis” and in practice is “very silent … seldom heard … the purveyor of analytic proof. … [B]y remaining anonymous [he] gains from a mysteriousness that implies an all knowing or magical persona … His feelings were to be seen as countertransference and, as such, needed to be contained, split off, for his own consideration but not to be shared with the patient.” For this analyst, the “search for the intra-psychic conflicts was the exclusive arena for psychoanalysis [versus a view that] the nature of the environment that a patient developed in greatly influenced the problems in living that each patient experienced in adult life.”
This is a reasonable description; many of us in the field grew up with it.
Although they may exist, I'd expect that few living analysts fail to recognize the role of the environment in shaping their patients. There probably are still analysts who appear to their patients to be mysterious, perhaps because they speak little. But with today's mainstream awareness of two-person psychology and decades of thinking, or at least hearing about, relational technique, I don't believe there are many who believe that being mysterious is a good idea, or would wish to appear magical as an aid for treatment. Similarly, the traditional analyst is described as seeing every communication from a patient as transference and failing to see his or her role as a real person. I believe most of our colleagues today would view that as simply bad practice.
Of course, in any field there will be people who are behind the times. We do need to remain alert to the problems of old and rigid technique where they still occur.
Key to this paper is the view that historical progress in understanding patients was not accompanied by a corresponding change in technique. It proposes a specific alteration in technique: “real give and take or conversation between two adults,” principally through greater self-disclosure by the analyst. The paper asserts that the reason this technique is not used is that: “If the details of the analyst's background or his political views or religious observation…have been disclosed, or enter into the analytic dialogue, it has been assumed that this will truncate the development of the supposedly necessary ‘transference neurosis’”.
In recent times, emphasis on the concept of a transference neurosis has declined as it has been recognized to be absent or only partially present in many successful analyses. Interfering with it is therefore probably less an objection to self-disclosure than in the past. Self-disclosure remains a source of significant concern for other reasons, however, as I will discuss later.
The paper also states, “the interdiction against self-disclosure [should be] dropped along with the insistence on neutrality and abstinence.” Neutrality ideally refers to remaining “neutral to the patient's conflict” (Hoffer) in order to make the treatment situation safe for the patient
to express his thoughts and feelings without fear of the analyst's disapproval, and to allow their free investigation. Abstinence refers to refraining from enactments which arise from unconsidered emotional response to a patient's affects or actions. There is nothing inherently problematic with these ideas. Specifically, neutrality and abstinence do not prevent discussion of an analyst's personal views if that is deemed useful at a particular moment in the treatment. Accepting a place for self-disclosure does not provide any reason to drop neutrality and abstinence as defined above.
The paper also emphasizes the need to lessen focus on transference and countertransference because of concern that this interferes with attending to the reality of the analyst and patient and their interaction as “real” people. Again, good current treatment attends to both transference and countertransference as well as the “real” relationship in the room. The balance between focus on transference/countertransference and the “real” relationship will depend on what must be attended to at any point in treatment, and will necessarily be different with different patients. It would mean abandonment of a great deal of the nature of psychoanalysis to, in general, lessen focus on transference and countertransference to a secondary level.
A similar view applies to self-disclosure. It may be important, or even essential, with some patients at some times. But it is widely understood that there are just as clearly times and patients where it would be destructive.
Consider a patient who suspects that he knows the analyst's view on a topic (religion, etc.) and to whom it is important to know that his perceptions/guesses are valid and respected, or that his analyst is going to be honest with him, since his parents were not. The analyst needs to appreciate whatever is the meaning to his patient at that point. It may indeed be essential that he answer the patient's questions to show the respect, validation and honesty the patient needs to see at this moment. To be clear, the analyst is not here being false or “unreal”. He does respect the patient and is honest with him. He is simply being thoughtful in his intentional choice of response. And, in this circumstance, if the analyst tells the patient his religion or his favored political party, neither neutrality nor abstinence is breached by this response.
But consider another example. An analyst reveals his memories of playing baseball with his father as a child. This may carry the meaning to his patient of being understood, included, valued and perhaps loved. It can be actively helpful in learning from a “new” relationship. But we can easily imagine a patient being damaged by the analyst revealing his personal history or views, because they repeat a relationship with an intrusive self-preoccupied parent whose narcissistic focus left the patient alone, depressed and enraged. Or, the analyst's self-disclosure may have a problematic meaning to the patient about the analyst which becomes a hard truth for the patient since it is seen as fact, because it was not the patient's fantasy but was revealed by the analyst. This meaning may create a lasting block that is very difficult to discover. There are of course other possible problems with telling a patient factual details of the analyst's life, including unspoken envy, disgust, anger, or an assumption of shared meaning (“You're from my country, I can now assume without discussion that we share views of this issue”).
With some patients at some points in treatment, intentional self-disclosure by an analyst might lead to the kind of “give and take” to which the paper refers. And for some patients an overall “give and take” relationship may be exactly what the patient needs. But this cannot be an overall recommendation for psychoanalytic technique because it does not apply to all patients most of the time or some patients any of the time.
The paper makes its strongest point in favor of greater self-disclosure and give-and-take in the observation that, “when talking to individuals who have had a traditional psychoanalysis…what they recall about what was important to them in their experience of their analyst was some small moment of unexpected human exchange with the analyst.” I very much agree that “traditional” technique often failed badly to recognize the impact and meaning to a patient of the analyst's withdrawn or aloof demeanor. It caused a great deal of harm by reproducing traumatic abandonment and loneliness, and worsening already existing self-doubt.
In my view, the major protection against such retraumatization is to be aware of its risk. All therapists must look for and understand their patients' (usually deep) need to be heard, valued and feel cared for.
Therapists must be aware that there will be times that self-disclosure is essential, and be the most helpful way to address these fundamental issues.
This paper reminds us of the dangers of an aloof, rigid, mysterious analyst, as seen in “traditional” technique. Keeping these warnings in mind, most of us are doing better. Modern psychoanalytic technique includes awareness that there are two idiosyncratic people in the room, neither of whom is omniscient. Most of us today agree with a central theme of this paper that self-disclosure should not be seen as a technical error or forbidden, but rather as a valuable option for the therapist. However, I do not agree with the paper that self-disclosure resulting in a “give-and-take” conversation should be the aim of psychoanalytic technique. Self-disclosure ought to be introduced with the same thoughtfulness as any other action or speech of the therapist, bearing in mind its potential problems. Its introduction depends entirely on what will be helpful and usable to the patient at the time.
We must avoid being the unavailable, retraumatizing, distant analyst of the past. We must attend to our patients' need for recognition, validation and respect, which may require self-disclosure at particular moments. That does not have to come at the expense of our awareness and focus on transference, countertransference, intrapsychic conflict, neutrality and abstinence.