Tuesday, May 1, 2012

Susan Thau - Ferenczi's "A Dialogue of Unconsciouses"

"Studying Sandor Ferenczi's therapeutic explorations, I have a keen interest in the process of communication between the analysand and the analyst. Ferenczi proposed the existence of "a dialogue of unconsciouses" (1) as an ongoing part of the therapeutic process. I will further expand on this concept of the dialogue with emphasis on the transmission of affect from an attachment perspective. Transmission refers to the sending and receiving of emotionally based material, while attachment refers to the primary connection that forms between two people who provide security and comfort for each other. This perspective includes findings from the emerging field of developmental neuropsychobiology which describes the process of affect transmission between the analyst and analysand as it affects the brain and body even when there is no conscious awareness. All of this relates to the analysand's efforts to communicate a deeply felt need for a stabilizing relationship, a longing that must often be camouflaged because of fears of the impossibility of this desire.

What does it mean to think about the dialogue of our unconsciouses? How do we actually speak to each other if we do not use words? Are we in communication at all times or only when we are speaking? Sandor Ferenczi thought about this dilemma when he began writing about technique in his efforts to understand what happens in the therapeutic processes. He was well aware that he and his patients were conversing on multiple levels simultaneously. He was fascinated by what he called this form of "receptivity" (1), or "thoughttransference" (1). Ferenczi laid the foundation for an early interest in this intense form of non-verbal communication, giving it legitimacy by poetically describing the presence of this phenomenon between himself and his patients. But that was just the beginning, and it is now time to develop a further appreciation for the magnitude and complexity of this process.

Let us start by considering the dialogue and the analysand/analyst relationship. My patients, wanting to engage my attention, describe in exquisite detail the conditions, and the circumstances, that have caused so much psychic pain. Understanding that this communication is for a purpose, I know that I must make sense of what the patient is trying to convey that may not even be part of their own conscious consideration. What is communicated through the dynamics of the therapeutic process may be more revealing than the content of actual words. Implicit in this communication, at all times, are the patient's feelings about the nature of their therapeutic relationship. Ferenczi was concerned about the inherent inequality in all analytic relationships. Because of the actual condition of inequality, patients need to feel safe and trusting that the analyst will not use his or her position without regard for the patient himself.

Analytic guilt consists of the doctor not being able to offer full maternal care, goodness, self-sacrifice; and consequently he again exposes the people under his care, who just barely managed to save themselves before, to the same danger, by not providing adequate help. (Ferenczi, Clinical Diary 1: 52-53)

From reading how he explores his own process in the Clinical Diary, I now believe that my attitudes and subjective perspectives, whether critical of the patient or not, whether fully examined or not, will be transmitted to my patients, regardless of my intentions and whether or not these perspectives are actually spoken about in words. In addition, the patient is not just a passive recipient but is actively engaged and trying to make sense of his feelings about the therapeutic relationship even when he is not aware of trying to do this. This stance compels me to conscientiously consider how I can be more sensitive to what my patients may be trying to convey regarding our relationship, especially because of the possible aversion to recognizing their negative feelings due to their inherent dependency on me. The paradox of this therapeutic relationship is that dependency, while rarely acknowledged, to some degree is always present. Trying to grapple with this problem, D.L. Smith developed an approach which he calls "communicative psychoanalysis" (2). Smith states that we must be aware that our patients are constantly evaluating our behavior as therapists. By getting underneath the spoken word, it is possible to begin understanding more about how the patient holds the idea of the therapy as well as the nature of the attachment or the lack of it between patient and therapist. It is almost as if the patient's presentation, worded and unworded is like pieces of an enormous jigsaw puzzle that must be carefully reconstructed in order to see the larger picture. Smith believes that because of the inherent inequity in the patient-therapist relationship, inevitably the patient will try to signal the therapist regarding the difficulty of dealing with this unacknowledged control and dominance. He advocates listening to the patient's narrative for the themes having to do with connection and attachment, recognizing that these themes can then be linked back into the current therapeutic relationship.

Moving from this exploration of inequality, I would like to address the area where inequality is embedded but quite illusive. I am proposing that this inequality is a frequent component of the unconscious dialogue, the dialogue that is not spoken but which is communicated between analyst and patient. I do this out of the belief that as analysts we must develop a more attuned sensibility to the tone, nuance, cadence and choice of spoken word, as well as noting the body posture and facial expressions as a means of understanding what patients are trying to communicate about themselves and their feelings about their relationship with us as analysts. There is no question that we can learn from our patients about aspects of ourselves which are revealed through the complex interaction of attunement, disruption and possibly repair. The latter refers to the possibility of an emotionally healing experience where a process of disruption is turned into one of mutuality and regard (3)." (pp. 114-115)

Susan Thau (2004). Dialogue of Unconsciouses: Conversations We Have Without Our Knowledge. International Forum of Psychoanalysis, Vol. 13, pp. 114-120

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