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Some months after the beginning of her analysis, a patient suddenly turned her head to look at me and, with surprise and disappointment, said that she thought I might be sexually excited. During the course of the analysis, we referred back to this bit of “acting in” in various ways. But of the most interest to my current purpose is an observation she made shortly before the end of the analysis about her “take” on my earlier relaxed and alert attitude. She said, “You seemed to be listening with everything you had.” Indeed, I had been listening with everything I had. The analysis was long and complicated, and the transference was sometimes highly eroticized, sometimes untrusting, sometimes rageful, sometimes hateful, sometimes loving. But what ultimately drove it was the conviction that I listened so intently that I could join with her in understanding her many-faceted life.
Every psychoanalyst would agree that such listening is an essential part of the analytic process, but I suspect that there would be less agreement about just what constitutes such a psychological state and how it is best facilitated. Specifically, what part does the patient's recumbent position on the couch play? Can we achieve the same thing sitting vis-à-vis? Has the couch become an anachronism—or more, an icon, a relic of our history—to which we make our obligatory obeisance? Or does it really play a vital role in analytic work? Could I have listened with everything I had if my patient and I had been comfortably seated facing one another?