From a supervision

 
Dr G. was an experienced psychiatrist, a gifted candidate in psychoanalytic training, intelligent, and warm-hearted. He reported how his patient had arrived for analysis: punctual but wet all over and blue from the cold. It was an evening when an especially icy rain beat down on the streets. The patient mentioned in passing that he had arrived at the analyst's house a quarter of an hour early (as he often did) but that he preferred to walk around outside than to come too early. Then he went on to other problems.

Dr G. described the course of one session, and I listened. His interpretations were, so to speak, entirely correct and also contained a reference to the patient's anxiety and inhibition. But Dr G. did not feel comfortable with his actions and suspected that I disagreed with him. So I asked him what he felt when he saw the patient completely wet and blue in the lips. Didn't he think of offering the patient something hot to drink! The student immediately confirmed that this had in fact been his first impulse. And he would have done so with a patient in his psychiatric practice, but while in psychoanalytic training he thought he was only permitted to give the patient interpretations.

It is true that many analysts do in fact insist that an analyst can only offer interpretations. This is one of the taboos I referred to earlier. Once I even heard a highly educated analyst recommend that we avoid asking direct questions and instead always make some kind of interpretation in the hope that the necessary information would be given.
I believe that this kind of manipulation is based on a serious misunderstanding. it overlooks the strength of the unconscious, the dynamic of the contact between analyst and patient, and the hidden processes that are an integral part of analysis and give it vitality.

Why can't I simply and honestly ask my patient for the information I need to understand his associations if he can easily provide it? Of course we all have our own peculiarities, but dogmas are at a different order of magnitude. I am often a failure at disregarding ideas if I suspect, although I am uncertain, that they are important. In such situations it has often happened to me that somatic language has thwarted my intentions (or made the decision for me!). My stomach growled suddenly and audibly. If the patient made a reference to it, it was usually easy to mention the suppressed comments and to examine them with the patient.

In this connection I would like to refer to another bit of nonsense. This is the equation that five hours a week equal analysis and that fewer than five are sins. In this regard, I recall Willi Hoffer, who was by no means a wild or heretical analyst. He told a committee discussing the criteria for the admission of regular members that he knows analysts who achieve more with a single hour per week than many others do with five a week. This was, of course. not meant to encourage analysts arbitrarily to reduce the amount of time provided to patients, especially if there were no corresponding reduction in fee (see Greenson 1974). It is noteworthy that Freud, who was accustomed to working six hours a week with his patients, expressly said that some patients require no more than three hours.

I certainly do not underestimate the importance for the analytic process of how the patient experiences interpretations, and I will have more to say about this later. Here I would like to state that - in contrast to Balint and Winnicott, who correctly emphasised the human element in the contact between analyst and patient and did not adhere to dogmas - I have never found it necessary to show patients my understanding of their anxieties by means of physical contact, such as holding their hand or head. Colleagues who follow Balint and Winnicott in this regard believe that I have never had patients in severe regression or never permitted patients to experience a deep but therapeutically necessary regression in which only physical contact is meaningful.

However, to return to the student I supervised, the interpretations that he substituted for his first and natural feeling that the patient needed a hot drink more than anything else were really 'substitutes The interpretations were lame; they lacked vitality. And the student knew it. To prevent any misunderstanding, I am not claiming that the analyst's mistake caused any lasting harm or that the patient was driven into a case of influenza. He was a young man who had spent his early childhood in the country, where he must have been exposed to wind and weather. The important point is the violation of the natural way of acting; that is, the violation of the fundamental principle and goal of analysis.

Each participant in the analytic process seeks and struggles for both, internal and external truth. The acknowledgement of reality, to which all psychic progress and opportunities for happiness are tied, requires that each exhibit a natural honesty.

Copyright © 2000 British Psychoanalytical Society & Institute of Psychoanalysis.

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