Reflections on the Concept “The Patient's Psychic Reality”

The concept the “patient's psychic reality” describes a fundamental epistemological and clinical position regarding the notion of reality. Two distinctions are implied: the patient's psychic reality as opposed to another's (e.g., the analyst's), and psychic as contrasted with objective reality. It is my contention, illustrated in some detail, that these distinctions are frequently clouded in our clinical propositions, and our methodology. We tend to speak as though the analyst's view—even about his or her own subjectivity—is the “truer” reality, and the patient's view however defensively or non-verbally communicated is more distorted, “transferencebased,” or, it is simply presumed. By thus blurring the boundaries between the patient's and the analyst's vantage point, we fail to distinguish between hypothesis and evidence, bypassing nuances of clinical data that do not fit the path on which we seem to be. Reflecting more rigorously on the question of how we arrive at what we believe we know may help us find our way far less inferentially onto pathways heretofore unconscious, deepening our recognition of multiple levels of the patient's psychic reality.