It Is All Interaction

Somewhere between viewing the analyst as detached observer and informed interpreter of the analysand's associations and viewing the analyst as active participant in the patient's psychic life, there lies a truth about the nature and degree of analyst-patient interaction. In another sense, however, there is a very certain participation of the analyst in every patient's psychology. Perhaps this lies at a different level from whatever the analyst may or may not do; that is, it is beyond overt interaction. It comes from the fact that inaction may count as much as action, silence as much as talking, and understanding as much as misunderstanding. There is no certain path to neutrality and/or nonparticipation, since the proper stance of an analyst is always to be able to be surprised at the results of his or her presence as well as behavior. Everything seems to matter, and so interaction needs to be considered along a spectrum of accidental to intentional, as well as incidental to meaningful.

If we assume that the patient always has an effect on the analyst and that the same holds true for that of the analyst upon the patient, then we need to clarify both the nature of the proper constraints of an analysis and how to manage and explain this inevitable mutuality of interaction. As to the first, it is clear that we evoke moral and ethical limits to analyst-patient interaction. We likewise insist upon actions or restraints that facilitate treatment. We abstain from physical contact, both because we feel it improper and because it impedes the treatment. But not everything is so easy since what belongs to the second category of helping or hindering the analysis is only determinable