Psychoanalytic listening II.

Abstract

This paper employs a rhetorical form designed to clarify and sharpen the focus of the very special stance required--which must be painstakingly learned under careful supervision--in order to effectively tune in to communications coming from the unconscious of the patient. This is the hardest task that must be mastered to become truly empathic and sensitive in dyadic relationships, a unique expertise that marks the psychiatrist as a genuine specialist in medical practice. Regardless of theoretical orientation, neither the form or content of any therapeutic intervention can be appropriate unless it is empathically based. Clinical vignettes illustrate the lack of such empathy, and readings are suggested that enhance our approach to learning this skill, borrowing especially from Kohut and Bion. The great importance of the often ignored "background" of the patient's communication is emphasized, and is illustrated from the field of music in the work of John Cage and Anton Webern. The congruence between this clinical psychiatric problem and the main thrust of Continental philosophy, which attempts to put man back in touch with himself, is described. Suggestions are offered to supervisors how to develop these skills in the novice. Finally, a discussion is presented of the effect on the professional and personal life of the therapist who has not developed these skills, emphasizing the dangers of "burn-out" in therapists and the implicit philosophy of life in a money-oriented practice of psychotherapy. The dangers of not attending to such matters even during residency training are pointed out, in an attempt to raise the consciousness level of the therapist to the extreme importance of background practices both in the patient and the therapist.