A Different Perspective On the Therapeutic Process: the Impact of the Patient On the Analyst

Abstract

The therapeutic process is considered from the perspective of its impact on the analyst. Analysts undertake self-scrutiny, focusing on transference and countertransference reactions, in order to facilitate the treatment of their patients. However, this self-reflection also serves to continue and enhance the analysts own personal understanding. In the course of analyzing patients, an interactional process develops in which many of the therapeutic aspects of analysis affect the analyst as well as the patient. A clinical example is offered to illustrate this process.

The Analyst’s Trust and Therapeutic Action

“…Although, unlike the analyst, the patient is not required to maintain confidentiality in relation to anything learned about the analyst or what transpires between the pair, the manner in which the patient deals with the analyst's spontaneous material undoubtedly affects the analyst's sense of trust and freedom in the analytic setting and consequently his or her openness and willingness to be self-revealing. As Kantrowitz (1997) observed, analysts are more apt to disclose when they trust patients' capacity to express freely the thoughts, feelings, and fantasies stimulated by the analyst, the analyst's interventions, and the analytic situation.…”

“…[p. 188] Although the asymmetry of the relationship means that the analyst is by definition in a "safer" position than the patient, therapeutic action requires the analyst to remain emotionally available, involved, and willing to engage, and hence, to be at times deeply moved, even disturbed, and thus vulnerable. The analyst, once involved in this way, engages in an emotional risk, and without that risk no psychological change can take place (Kantrowitz 1997). The analyst's self-protective pursuit of safety is associated with the need to cope with the possibility of overwhelmingly fragmenting anxiety, humiliation, or harsh retaliation, inimical to an experience of trust.…”

“…Empathic attunement, the cornerstone of the analytic method, depends on the analyst's remaining emotionally open and thus vulnerable to the patient's affects, imagery, hopes, and fears, as well as the analyst's own. As Kantrowitz (1997) noted, true emotional openness, seen as crucial for change, is not undertaken lightly by analysts, but requires trust in one's own capacity to withstand the intensity of the patient's affects and whatever associated fantasies, wishes, and fears they may arouse in oneself. Likewise, the analyst's authenticity depends on an ability to remain emotionally open while striving to be as sensitive as possible to both his or her own and the patient's internal processes.…”

“…The patient is enabled to express, in order to work through, transference with greater openness, fullness, and intensity, once the analyst's essential trustworthiness has been accepted (although it is repeatedly tested throughout the encounter). As patients' transferences are worked through, reciprocally, the analyst ordinarily comes to more fully know, respect, and thus trust the patient, and consequently to unconsciously move closer and to become more open and vulnerable (Kantrowitz 1997). When that happens, the analyst, like the patient, experiences a greater "willingness to be known" (Frank 1997), which, while to some degree conflictual, facilitates mutual recognition and an intimate meeting of two individuals who together can live through an insightful new relationship that benefits both.…”

“…Intersubjective considerations generate interest in the conscious and unconscious qualities and actions of individual analysts, how analysts as well as analysands understand and express their conflicting expectations and needs, and, especially, how analysts beneficially negotiate and constructively integrate these personal factors in the analytic relationship (S. Pizer 1998;Smith 2000). Recent papers (Davies 1999;Kantrowitz 1997) have alluded to the role of the analyst's trust. These articles, and the scarcity of others related to this neglected topic, suggest the timeliness of analysts' beginning to consider systematically the role of their own experiences of trust and distrust in analytic treatment.…”