A Conversation With Evelyne Albrecht Schwaber

TJ: You are known throughout the world for your pioneering work in analytic listening. What led you to become interested in this aspect of analytic work? How did your experiences as analysand and analyst influence you in pursuing this interest? Who were the mentors, teachers, or colleagues most influential in the development of your work?

It has been said by some colleagues that at heart you are a self psychologist and that your approach has much in common with the techniques, if not the theory, of self psychology. Do you agree with this view? How do you compare your perspective with that of Kohut and later self psychologists?

EAS: My answers to these questions can be woven together. In a paper published in 1983, I wrote of my experience with my first two analytic supervisors, in which I noted that while both were excellent clinicians and teachers, they had strikingly different modes of listening to patients. When I listened to my first control patient through the viewpoint of my second supervisor, the symptomatic phenomena that had emerged seemingly randomly on the couch began to take on a rhyme and reason that deepened our understanding of them and their historical anlage. When I worked from the first supervisors approach, I was trying to “educate the patient's ego,” so to speak, to help her with her difficulties in reality testing. When I worked from the second supervisor's approach, I tried to locate and articulate her perspective more closely. The differences in what emerged and what I could learn were remarkable. My supervisors were basically in accord about theory. I began to recognize that how one listens is a matter transcending one's theoretical predilection.

In the 1983 paper, I also wrote of the influence of Kohut's early work on my thinking. Kohut's writings, in the late 1960s and early 1970s, were part of the recommended core readings in my analytic training. I was struck particularly by his ability to go beyond his predetermined theoretical stance, as with Miss F. in 1968, to hear something else that the patient was conveying. It was the moment of his discovery — in this case, that he had been recreating the responses of her depressive mother, and the implications he derived from that—a moment permitted by his capacity to let himself be derailed from the clinical path he was taking, which intrigued me.

This was before self psychology became what I saw as an opposing, rather than an augmenting — and a more reified—model of the mind. It was a stance that resonated with Freud's early clinical discoveries, in which Freud allowed himself to hear things his patients were saying that far transcended his prior assumptions, and then led to new understanding of the human psyche.

It is this position for which. I argue: to permit ourselves these moments of discovery in our everyday work, to go past our presuppositions, to detour from our path when it seems some clinically immediate cue doesn't fit or suggests another question. This is not to imply that we become atheoretical in our stance; we can't anyway. But it is to recognize the continuing risk of using our model of the mind — be it self psychology or another — as though it held a greater Truth, to foreclose rather than deepen our inquiry. While this is bound to happen unwittingly, we have much to gain in finding ways to learn about its occurrence from our patients.

Among the teachers who have been particularly helpful are Milton Rosenbaum, José Barchilon, and Erich Lindemann, who made it possible for me to do my residency part-time when my children were little, when this was still a new and controversial idea; Robert Gardner, the supervisor who opened my eyes to new possibilities in our mode of listening; Malvina Stock, who always reminded me, “If you don't understand, ask”; and Elvin Semrad, my training analyst. Semrad was a legend in the Boston community, in conveying his mode of clinical attunement. Samuel Kaplan, my supervisor in child psychiatry at Boston City Hospital, has been an invaluable reviewer of my ideas in process. It was at BCH also that I met Louis Sander, whose research on infant-caretaker interactions, state, and state regulation was to have a continuing impact on my clinical thinking.

TJ: You have also been described as an analyst who is primarily interested in interpersonal issues, viewing the analytic process as centrally involving the interplay of the psychologies of patient and analyst. Are you an interpersonalist, an intersubjectivist, or a traditional analyst who uses an intrasubjective perspective in your work? Many colleagues are confused as to what, in your opinion, constitutes the essence of the analytic process. Could you clarify this?

EAS: I am a traditional analyst. I have been subject to a fair amount of criticism by interpersonalists, intersubjectivists, self psychologists, and others. If some have said that I am an interpersonalist or intersubjectivist, others who subscribe to these models have criticized me for not being one of them, or for being too “radically empirical.” In a paper on psychoanalytic theory and its relation to clinical work in 1992 (which received the Hibbs Award of the American Psychiatric Association for the best paper on a clinical subject), I shared my view that psychic reality and its evocation in the transference is the bedrock of analytic theory, and that we are still grappling with the extraordinary implications of this. I have posited that Freud's discovery of the transference reflected the entry of depth psychology into the scientific era of relativity. I believe it is the recognition and elucidation of the patient's hidden inner world — which includes memory, perception, fantasy, wish, defense, and the varied modes, verbal and nonverbal, by which the patient communicates or disguises awareness — and of the bridge between past and present, that constitute the essence of the analytic process.

There is nothing untraditional or radical about this view. What I emphasize is the difficulty we have in sustaining this stance (and in this I hold myself to account); the tendency toward closing off nuances of communication, including those suggesting how we are being perceived, that may have led to yet untried paths. In my plenary address, I wondered,

Perhaps there is something in this stance — my advocacy of the sustained, painful, often jarring pursuit of seeing ourselves, our values and assumptions, through the patient's eyes, often initially unconscious to her, or resisted by her, a reflection we may not have in awareness otherwise, and a perspective on transference (still expressing the past, but) behind which we cannot hide — that makes my position so often, and for such seemingly disparate reasons, so controversial. For I do not forego my own vantage point, nor can I listen without a theoretical base; I do not seek to empathize as such, but to invite often rigorous reflection; I must draw upon my separate view to guide me to what may lie hidden in hers.

TJ: You have had a dispute in the literature with Jack Allow who, in his article on stilted listening, criticized your approach as having neglected to explore the unconscious fantasy contained in a particular figure of speech used by a patient. In your work do you, in fact, give priority to the interpretation of interactive elements over unconscious fantasy? How do you view the relative place of these two perspectives in analytic work?

EAS: I certainly would not see myself as giving priority to interactive elements over unconscious fantasy. It is precisely my view, in agreement with Arlow, to call attention to the fact that salient material can be bypassed if we are wedded to a model, agenda, or value that assigns a skewed priority to one element in the patient's communication over another. In the paper to which you and Arlow refer, I wrote that by listening to the cues communicated by the patient, I learned of such an agenda I had held, actually based on a value system rationalized as consistent with a theoretical model of his defensive structure, which had escaped my notice. I did not then have to choose between the interactive elements or the unconscious fantasy, but could learn how they were intrinsically interwoven. The patient's perceptual experience of my intervention, and the history it re-evoked, lent the context to his fantasy. I will further elaborate on this apparent debate in a forthcoming paper in the Psychoanalytic Quarterly.

We need to remember, when we speak of unconscious fantasy, that so long as it remains unconscious, the analyst as well as the patient cannot know it but can only infer its possibility. As I have written, “we can only know what is ‘unconscious’ once it has become past tense.”

TJ: In recent years, there has been increased interest in countertransference issues and emphasis on the inner experiences of the analyst as valuable data in analytic work. Can you explain how your approach of listening from the patient's point of view, which would seem to preclude the analyst's also listening to her own reactions, enhances the analyst's ability to tune in on her inner world?

EAS: Again, my effort is to try to locate the patient's point of view. To do so, I must use my own. It seems to me this is what we each set out to do, since the patient's inner world is our psychoanalytic database. And by point of view, I also mean what is hidden, disguised, defended, expressed nonverbally, outside awareness. Of course I attend to my own reactions; my interventions and questions stem also from these reactions. For example, I may ask about what, from my point of view, I don't understand.

One implication of your question may be, what do I do with my awareness of my own reactions? They may help me better understand myself and what may be evoked in me in relation to my patient, and thereby help me consider the patient's responses in the light of my own — as long as I remain mindful that I cannot use what I feel to tell me the patient's unconscious intent. But what I have particularly emphasized in my writings are those feelings in myself of which I was not aware until learning of them by listening to, and exploring, what the patient communicated. The patient may have much to tell me about myself which I — or even he or she — had not otherwise seen.

TJ: You have been trained as a classical analyst. Do you still endorse classical views with regard to such matters as structural theory, pathogenesis, symptom formation, and technique? If not, how do your current views differ from the classical perspective as it has been handed down from one generation to the next?

EAS: Yes, I still endorse classical views, and yes, that includes the classical perspective as it has moved from one generation to the next. Surely it has evolved for each of us; that is part of its inherent strength. I might have asked, “What do you mean by ‘classical’ ?” — for each person's and each institution's understanding of it may vary. You were trained at the New York Institute, and I in Boston. This difference itself may affect our meanings. The two supervisors of whom I spoke were each considered classical. I was also taught and influenced by Arthur Valenstein, who argues cogently for maintaining the distinction of the concept of classical psychoanalysis while recognizing the variances in its definition, and whose own views continue to evolve even as he sees them as consistent with the classical position.

I see classical analysis as relating in its essence to our focus on the intrapsychic, with its wishful, fanciful, and defensive elements; on the lifting of what had been unconscious; on the centrality of the transference and its importance in linking past to present. The concept of interpretation, while itself in evolution, is also embedded in the classical view. I have written about my understanding of it — again, distinguishing between interpretations of the inferred unconscious and interpretations of what has surfaced for potential collaborative observation. Basically, as I've indicated, I do not argue for an alternative model of the mind, but for a more rigorous attendance to how we use the model we espouse.

TJ: You have been interested in both nonverbal and verbal aspects of communication. Can you share your view of the role of nonverbal phenomena in analytic work and how you access and make use of this material?

EAS: I believe that nonverbal cues are a central aspect of our clinical data that we need to try to articulate and elucidate. Brought to the patient's attention, without assumption of meaning, the nonverbal — including state and state shifts, a concept about which I have recently written — can be mutually observed, put into words, and analyzed. It carries a wealth of data, sharpening consideration of the nature of our analytic evidence, and it is where much that is otherwise unconscious is expressed.

TJ: On a more personal note, I wonder if your religious background and your interest in religion may have influenced your thinking and way of working as an analyst. Being religious and an analyst are often viewed as incompatible positions. How have you been able to reconcile them?

EAS: It is very likely that my spiritual leanings have influenced my analytic thinking. I believe they affect my understanding of the significance of fantasy, metaphor, and psychic play, for example. They have lent to my effort to search for the inherent legitimacy in another's way of thinking or feeling, (and of course this is a different matter than how one puts this into action) to seeing possibility in perspectives that might alternatively be dismissed as simply “magical thinking” or otherwise irrational.

You ask about being religious, which I see as reflecting a way of feeling, an inward state, that may coincide with a sense of spirituality. It is different from being observant, which has to do with how one practices one's religious beliefs. One can be religious without necessarily being observant by the standards of organized religion. In my own Jewish practice, I am moderately or flexibly observant by Orthodox standards, though to others I may seem rather strict about it.

Yes, there was a time when being religiously observant was considered at odds with being an analyst. I personally suffered from that prejudice; I was nearly turned down from seeking analytic training because of it. After, apparently, much debate about this, I was finally accepted. Friends advised me to see Semrad for a training analysis. He was a practicing Catholic and highly regarded clinician. He was very respectful of my religious choices and did not immediately assume these were neurotically based. As we know, other of the earlier assumptions in our field, such as, for example, our views on female sexuality, have been seen in retrospect to have arisen out of societal prejudices — lifted in keeping with shifting cultural awareness and values — rather than based on science or observation.

TJ: This is a time of a good deal of change and ferment in analysis, with new ideas and perspectives challenging traditional ideas regarding theory and technique.

Do you have any thoughts about the direction analysis in America is now taking and its relationship to our traditions? Are we undergoing a paradigm shift, or are the changes in thinking and technique we are seeing compatible with established theory? How do you envision analysis developing in the next decade? Are there areas of theory or technique that need revision? Can you share any thoughts about how analysis can improve its status both in the public eye and the scientific community?

EAS: My opening remarks from my plenary address might, at least in part, respond to your question: