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Back to Original Therapy
or Remarks on the Point "Modern"
Psychoanalysts Miss

The art of listening to the patient's discourse is essential
 if we mean to understand the logic in the patient's neurosis
and thus be able to help.

By Jean Chiriac

First steps in the elaboration of psychoanalytical therapy were taken not by Freud but by Dr. Breuer, who was no  specialized psychiatrist or psychotherapist. This first attempt was his treatment of Anna O.'s case, and the method was called talking cure. It had been suggested by the patient herself, and the experience concerning psychic investigation through hypnotic suggestion was adjusted to the case. The thing any true analyst may notice on approaching the Anna O. case is the analyst's (Dr. Breuer's) abilities as a listener. He listens and learns (how to cure) from the patient herself. In spite of his initial pre-established therapeutic starting point, he can still adjust his technique depending on the patient's contribution. Aside any technical bias, the art of listening, therefore, of almost completely leaving aside theoretical knowledge, of connecting to the patient's real problems makes the beginning and the end of psychoanalytical treatment.

Let us imagine ourselves traditionally sitting next to our patient, our mind devoid of all prejudice, listening to the patient's discourse. There are certain excerpts of that speech that can be looked upon  as signs for diagnosis as they evoke known structures of disturbed psyche. For instance, present expressions of hostile feelings to a person of the opposite gender may hint to the presence of some Oedipal complex. In  this case, the psychoanalyst's "art" - and I insist on the word "art" as opposed to impersonal engineering technique - relies on the specialist's refusal to label the patient's case as known fact. Specialists have to  listen on by ignoring psychoanalytic ideas and concepts awakened by the patient's discourse. Which is most important, they have to therefore go beyond therapeutic prejudice or intellectual counter-transference.

This is a no easy attainable performance as the psychoanalyst knows (believes) him/herself to be a PSYCHOANALYST, that is a character endowed with psychoanalytic therapy competence. He or she has a diploma  crowning years of hard study, published works and attending psychoanalysis congresses, etc. Therefore the psychoanalyst is (thinks he or she is) an authority in psychotherapy and, as a result, will only very stubbornly  accept there are (still) things he or she may learn from the patient. The specialist's entire successful professional and university proves an obstacle in his or her understanding the case and adopting a therapeutic  attitude that should suit the patient.

What is going on, actually? Psychoanalysts believe that need to adjust their therapeutic position (or technique, if we mean to) depending on transference and  counter-transference, on the demand to create that emotional and intellectual environment facilitating the patient's confession. Specialists start from theoretical considerations and act according to these. They thus  elaborate new therapeutic techniques, which, in their turn, will hinder their listening to the patient. No matter how elaborate, justified and "up to date", the technique is no more than a mechanical tool to approach  the case. For instance, if I set upon myself to follow the patient in his or her regression to the level of pre-genital, narcissistic fantasies, or to adopt the position of the patient's Superego or Ego, etc., the only  thing I do is mechanically apply an immutable therapeutic disposition which, in 99% of the cases, proves inadequate. Actually, all one is able to do in relationship to patients, and that on an intermittent basis too,  is to be willing to listen to them, try to make out the inner logic of that specific life circumstance customarily called neurosis! That is in fact what Freud himself requests when mentioning the relaxed, sympathetic attitude to the patient.

Sympathy is the emotional drive aiding us listen. Nevertheless, it should not be used in a  constrained manner. Sympathy emerges of itself, in a spontaneous manner, and gets "imposed" only where the case requires it.  In case: 1. Sympathy is not deliberately, artificially imposed, like a technique, or 2.  Sympathy is not compulsive, it is irrelevant whether or not sympathy relates to the elements concerning the psychoanalyst's counter-transference!

The therapeutic technique needs to be non-technical.  It is not technique that is required but a noncommittal attitude to the patient's problems. But that attitude must not turn into a technique either but it should remain something natural, unfeigned, even if emerging  non-regularly but rejecting dogmatism by all means.

Let us now conclude that the art of listening to the patient's discourse is crucial, if we mean to understand the logic of the patient's neurosis, and be  thus able to provide help. Any technical, predetermined position in relationship to the patient's problems is inadequate. That is the aspect of analysis "modern psychoanalysts" entirely miss!

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