Response

It is an honor to be invited to respond to Jean-Michel Quinodoz's most interesting and richly illuminated clinical example portraying a deeply searching, candid, and self-reflective analytic work.

Shared in subtle, sensitive detail, this material offers an enhanced opportunity to engage the question of our mode of analytic listening. Lying at the essence of our clinical work, transcending our theoretical predilection as well as our own particular psychoanalytic culture, how we listen warrants, I believe, continued reflection. I shall draw upon Dr. Quinodoz's finely presented case in further pursuit of this question.

It has seemed to me that steeped within our listening, in the effort to bring forward what is unconscious, we incline toward inference of hidden meaning or intent, buttressed by our theoretical suppositions, and then attempt by our interpretive stance to guide the patient, however gently, toward recognition of what we believe we have already come to see. Discussions on technique have pivoted largely on how best to help the patient move in such a direction. While we may be open to reconsideration based on the patient's response, there remains nonetheless a fundamental epistemological quandary in the view that we can see meaning yet unconscious to the patient, for, indeed, we can only conjecture about the possibilities. What is unconscious can only be known in past tense, that is, once it has become conscious. Believing that the meaning lies unbeknownst to them yet perhaps to be seen by us, we lose sight of the fact that our vantage point, even our view of ourselves, is simply that—ours; the patient may have another, the inherent legitimacy of which is still to be found. We tend, thereby, to not ask, to not take our patients at their word, to presume defense when their perceptions do not match our own, or to skip over inquiry into passing communications—verbal and nonverbal, such as state shifts or pauses—that may, albeit seeming to derail us, lead to paths