Meetings of the New York Psychoanalytic Society

December 8, 1987. PSYCHOANALYTIC OBSERVATION. James H. Spencer, Jr., M.D. and Leon Balter, M.D.

The recent focus on empathy as the essential activity in psychoanalytic data-gathering has led to an underemphasis on the complexity of psychoanalytic observation. Such a focus results in a failure to assess what makes psychoanalysis truly unique among modes of psychological investigation. In gathering the data needed for clinical practice and for theory-building, psychoanalysts make use of two distinctly different kinds of observation: introspection-empathy and behavioral observation. With the first mode, analysts put themselves mentally in the position of the patients in order to understand, through their own introspection, what the patient is thinking and feeling. The analyst understands the patient as the patient understands himself or herself. With the latter mode, analysts objectively observe patients' behavior, particularly verbal behavior, without reference to whatever meaning or motive the patients may attribute to it. This objectively observed behavior may be understood in terms of hypothetical constructs, internal psychological processes such as unconscious fantasies, and defense mechanisms.

Freud's instructions to patients for free association require that patients observe and report the conscious contents of their minds as a behaviorist would. The patient's adherence to the fundamental rule results in a state of mind characterized by a regression of ego functions. A similar result occurs in analysts when they listen with evenly hovering attention. These regressed states of mind are functionally related: they form what Isakower called the analyzing instrument, a unique investigative tool which gives both patient and analyst access to an observed field which is more directly and visibly influenced by the patient's unconscious mental life. The process of observation in the psychoanalytic situation is complex. It makes use of both empathy and behavio