I was on the phone with some colleagues yesterday, two analysts with whom I’ve shared a biweekly, cross-country conference call for 6 years. It started out as a study group I called the Open Study. We usually read anything but psychoanalysis which, since we are all psychoanalysts, has been very refreshing. Then, of course, everything we read – science, math, postmodernism, fiction – reflects on our work and thinking as analysts so we always talk about it all.
Anyway, the question of Freudian v. Interpersonal theory came up. Both are rich ways of thinking about people. I just don’t believe in the either/or choice any more, if I ever did.
There’s no one good way to describe human nature or to predict or explain our actions. I think of human nature as infinitely curved space/time.
If Albert Einstein, Neils Bohr, and The String Theorists (yes, the band has been formed)) can’t get it together on a Theory of Everything, I don’t see why we should expect ourselves to have to choose one school of thought to represent everything we’re about. Aren’t there zones of experience in which some theories are predictive and other zones in which they just make no sense at all?
Look at the argument these days between the economic rationalists and the behavioral economists; you’d think they just discovered human beings. Sometimes we’re reasonable, sometimes we’re not. I guess that attitude is not going to get you a Nobel Prize.
Freud really nailed some aspects of our internal lives. If you’re at all honest with yourself you’ll recognize the distress on your little girl’s face when you shut her out of your bedroom and she tells you she wants to marry Daddy. There are just some themes in our developing lives that return repeatedly.
On the other hand, hunger, sex and aggression are not all there is to life. Monkeys will starve themselves to hang onto a cloth-covered wire monkey rather than to a bare wire monkey where the food is, apparently because of the sense of comfort and closeness the cuddly texture provides.
People do make sacrifices for each other and people do kill themselves because they feel lonely. There are no simple explanations for how all these aspects of human life fit together, so we should probably just tolerate that the terrain is not flat, linear, and governed by a few rules; it’s curved and lumpy and there’s different weather around the next corner.
So how do you know which is the right type of therapy? There have been many comparative studies on the effectiveness of therapies. One consistent result is this: the best therapists from different schools of thought are more similar to each other than they are to the others in their schools. What they’re able to do isn’t dictated simply by their particular technique or philosophy of mind; they’ve accomplished something at a higher, personal level and only partially as a function of their training.
A good therapist cannot sit there and apply rules and follow guidelines. A good therapist has to make a connection with someone. She uses her training to modulate her impulses, maintain a certain curiosity and a critical balance between closeness and distance, all while helping the patient stay in touch with himself. These elements are common to most treatment modalities I can think of, including primal scream.
When their treatments are over the patients of all those great therapists would probably have different ways of describing their experience and have different explanations for where they went wrong in their lives and how they put things right. But the patient of a great therapist will be doing a lot better no matter which great therapist he saw.
So does it matter what we tell our patients? It wasn’t until I was well into my career that I recognized that my effectiveness had less to do with what I actually said to my patients and more to do with how I was thinking about what was going on.
When I first started, I believed that I had to tell my patients whatever I had just figured out about them. In telling them I often became wrong when (and because) I was interrupting them.
A very insightful analyst, Donald Winnicott used to say that he interpreted at the edge of his understanding. It’s a complex statement; he was telling the patient how far he had come with her which is important if you’re pacing someone and if the patient is looking to you to confirm that you understand. But often, your patient doesn’t need to know exactly where you are. And it’s not always easy to tell when she needs to know and when she doesn’t. If the patient is swimming along well enough, a clever word from you is often just driftwood not a lifesaver.
That doesn’t mean I don’t talk with the patient. Understanding, in some way, is essential to the experience of being heard. But it’s easy to get caught up in the project of understanding, whereas the sense of things tends to shift as you open up opportunities for life. The story loosens up so it’s important to leave room for it.
What I say to the patient is often for the purpose of keeping the conversation alive and exploring and less for the purpose of getting something exactly right. When it’s time to move in and contain the experience with a meeting of minds, of meaning, that’s what we do. But at other times my focus is to track the live edge of my patient’s attention and curiosity while helping her to modulate her anxiety in order to stay there. That is a skill that any good therapist absolutely must have. Otherwise the patient can become overwhelmed and possibly blow out of treatment, or become too comfortable and feel bored, neglected, and lose her curiosity.
Of course, moving more fluidly among these three states – the live edge, anxiety, boredom - and others besides, is part of what a patient needs to learn. And it’s also part of learning about the analyst’s tribulations in relation with the patient. A lot of analytically oriented (or, as some people say, psychodynamically oriented) treatment is about recognizing the ins and outs and ups and downs of all these interactions. It’s these moment-t0-moment experiences in which we find the assumptions and expectations that shape our relationships (to be elaborated elsewhere).
So, among the goals of treatment is managing states of mind. When tracking the live edge, a therapist models a way of self-soothing and proceeding, rather than collapsing into despondency, dissociation, or any of a number of emotional eddies. Be careful, though; what’s live is not necessarily what’s exciting or entertaining or being said. It’s an emotional alertness, not necessarily a noisiness. Then there are refractory periods, times for retrenchment and consolidation. We grow and we rest.
Again, the point is not to avoid all emotional ups and downs, the point is to learn to ride them and to develop some wisdom and skill in managing how long you spend feeling what you’re feeling.
So why is the live edge important? Because when people start therapy, it’s because they’re stuck somewhere. The live edge is where we’re ready, where we’re no longer stuck, where we’ve found some thread, some internal resource that enables us to take on what’s next.
From a certain point of view, theory serves this experience, not the other way around.
