Psychoanalysis: from the talking cure to the listening cure

In 1895, before the term psychoanalysis was adopted, the verbal therapy offered by Freud was described as talking cure, or chimney sweeping. It was noticed that the very act of talking could alleviate the symptoms by discharging the energy repressed. However, Freud soon realized that the cathartic effect of talking was temporary, if not matched with an adequate listening. Indeed, I propose that the birth of psychoanalysis has been possible because of this shift from talking to listening. Listening is probably the term that best sums up and captures the essence of psychoanalysis, and this different emphasis on listening rather than talking is likely what distinguishes psychoanalysis from all other (more recent, but pre-psychoanalytic) therapeutic approaches. But then: what listening? How to listen to the unconscious?

Psychoanalysis is not psychology, psychotherapy, or medicine. Part 3/3

this is the following of a previous part, which you can find here:

http://diegobusiol.blogspot.hk/2013/05/psychoanalysis-is-not-psychology_30.html


Part 3:

  

Psychoanalysis differs from any other practice also because it makes a different use of the transference. Transference is what ties one person to another. At the same time, it makes the relationship irreducible to the two persons; it indicates that there is more. It is what makes possible to address a question to someone. Transference is not just the repetition of a past relationship. Transference is not an accident; it is at the same time the motor and the resistance of a cure. It is what allows a process to begin, but at the same time it may be what opposes to this process to produce a change. In psychoanalysis the transference is considered by the psychoanalyst. He or she should be aware of the transference, and should be aware that it is more important the position where s/he speaks from, than the content of his/her words. Being a psychoanalyst means that one is occupying a particular position in someone’s discourse, and this position should be preserved. A psychoanalyst cannot really believe to master some specific knowledge or technique. A psychoanalyst occupies an empty place, and this emptiness is what provokes the analysand to produce his/her knowledge. The analyst should resist the temptation to feed the client, to answer him/her. Instead, the position of the analyst should be preserved, because the analyst works at the one to whom a question can be addressed. 

This is obviously just a fiction, because the addressee is the Other. The Other has a capital letter because it indicates a radical otherness, a radical difference. It means that the “I” is not fully master; it means that we are ruled by the unconscious, and we have to deal with this. Not only we are not “master in our home” (and for example we are subjects to the symptoms), but it means that we cannot fully know our desires, and our phantasm until we go through it. This means that we can only know something of our unconscious desires when we start talking. This is the only condition at which we may be able to see something happen. Only talking we may discover something about our desire, because when we talk we have the chance to listen to our speech, and we have the chance to encounter something of our unconscious, even though it sometimes come up through lapse, slips of tongue, and other unexpected, funny, and may be not always pleasant ways.

 

So, what psychoanalysis shows is that we are occupied by the Other, which is also the culture in which we were born, the normative Other, the system, the society, the family, etc…in short everything that is unconscious and has shaped our discourse. We were born in a discourse, as part of a current discourse; we are sons of our times. But still, we have a chance: listening to the discourse in we are caught, so that we can go through that discourse. This will result in less dependency by all the identifications and beliefs we have gained before. And of course, we can decide to stay still within the same culture, within the same society. But a journey has begun, a journey that may leads to reconsider all that we say, and don’t give anything for granted. This journey is not against society, and it is not against living with others. Psychoanalysis will not make of us more individualistic people (this is a frequent prejudice). Instead, it may lead to a different living with others, as it may lead to encounter the solitude. Solitude means that speaking (and every word works by difference to another word) we differentiate by the mainstream. But at the same time we differentiate by our “self”. 

Psychoanalysis follows the unconscious, and the unconscious has nothing to do with the individualism. Individualism and collectivism are just two sides of the coin, and both are ways for avoiding the unconscious. Psychoanalysis shows that we are always in relation to the Other; this means that we cannot erase it, we cannot erase the unconscious. Being alone and self-sufficient is thinking that we can skip the unconscious, that we can cut it out. Living all together, living as a group is another defense from encountering the unconscious. The group is the idea that we can replace the Other with many others; it is the idea that living with others we can avoid the anxiety that encountering the unconscious may give.

So, psychoanalysis is not a technique for managing the anxiety, or for limitating it. On the contrary, it shows that anxiety is much related to the unconscious, and that a bit of anxiety is probably necessary. But anxiety seems to be something pathological. Medicine proposes to reduce anxiety with pills; psychology teaches how to manage anxiety and reduce the stress; psychotherapy help to prevent anxiety and substitutes the irrational beliefs. But psychoanalysis proposes to listens to such anxiety, as this is a chance, because that anxiety may shows the way to a treasure. Psychoanalysis shows that fear may be real, but the danger is only imaginary.

Psychoanalysis is not psychology, psychotherapy, or medicine. Part 2/3

this is the following of a previous part, which you can find here:

http://diegobusiol.blogspot.hk/2013/05/psychoanalysis-is-not-psychology.html

Part 2:

Today it seems that everybody is affected by some symptoms (symptoms are very fashionable. They are like a dress, they normally last for a season, then are replaced by different symptoms, and we almost don’t hear about the previous anymore). We see pathology everywhere. So, for example, now the Attention Deficit Hyperactivity Disorder (ADHD) is very fashionable today, and the kids are suddenly very troublesome. Or they are very bully. But no one asks where such phenomenon come from. Nobody concerns to listen. All are worried to find solutions. Solutions are answers that we give to problems. But problems are easily given for granted; the premises are rarely investigated. Every practice (medicine, psychology, psychotherapy) has its own answers, its own techniques, and its own ready-to-use solutions. This is obviously quite impressive for the audience, and for clients. It is obviously more impressive to provide answers, no matter how superficial they are. Giving answers sets a limit to anxiety, and I would say regardless to the content of the answer. Understandably, many clients want to feel that the therapist masters some knowledge and has the answers. This is what people expect from specialists. Because knowledge is like a rock on which we can hang on. Without the rock of knowledge, we may feel lost. The anxiety would be overflowing. But in this case, it has to be said frankly that the only specialist can be the client, who indeed in psychoanalysis is expected to become the analysand.

But it normally works for a limited time. Freud too has begun with hypnosis, but soon he abandoned this method. Instead, a more fruitful and farsighted way is to focus on the question, rather than the answer. Elaborating the question is the most difficult task, but at the same time it is the more pragmatic, and the more concrete.

 

What is a question? A question is not a request, nor is a demand. A question is an investigation. A question opens. A question introduces a bifurcation: from the 1 to the 2. It shows that something else is possible. So, a question doesn’t aim at suggesting simply another solution (this or that). A question is not just an alternative. It is something more, because while we pose a question, we operate a shift of position in the speech. A question opens to the un-thought. A question introduces some new element; it is not simply a translation from one language into another. A question is effective when it makes think differently, meaning when it subverts our beliefs, finally when it opens to the Other.

 

So, psychoanalysis doesn’t go in the direction of a universal knowledge (like medicine, or psychology, or philosophy). Instead, it shows that even similar symptoms can have for everyone different grounds, and different place in one’s history. So, psychoanalysis is for each one a different journey. It may happen that people go through the same questions (who am I? where is my desire? Why I cannot get what I want? Etc…) but everyone will articulate different stories and go in different directions. What psychoanalysis shows is the singularity of the case. Every case is different from another, and it is not possible to refer to something like a manual of psychoanalysis, or a dictionary of dreams, or a dictionary of symptoms. There are no definitive answers. This is also the reason why psychoanalysis is virtually un-ended, a lifelong journey.

 

So, of course posing questions is not easy. We all want to find answers, and we all want others to give us the answers. Normally when a patient comes to us, he or she speaks non-stop for 45 minutes, and then tell us: “Ok, now I think I have told you everything. So, what is my problem? What is the solution”? Everybody expects to find the solution in few sessions. But actually, since there is no pathology and no disease, then there is no solution too. The point is that everybody can give an answer. But what is really difficult is to pose the right question. This is what we can do: posing and further articulating questions. This is the only starting point. Of course some clients are disappointed when we make questions and don’t give answers, but this is the only chance for them to try articulating their answer. This also leads us to think the position of the psychoanalyst.

 

Who is the psychoanalyst? Is s/he someone who really has the answer? Maybe yes, maybe no; this is not the point. Even if the analyst possessed the answer, this would be quite useless. Psychoanalysis is not just a matter of transferring information, from an expert to a novice: knowing something doesn’t produce any change. So, it is the client (in psychoanalysis is named analysand) who has to go through this process, with his/her speech. It is not the content of the talk that is important. Important is that the analysand goes through the process, through this imaginary knowledge. Important is that s/he goes through, meaning that there is not an ultimate, definitive knowledge. Psychoanalysis is a process of losing something (identifications, beliefs, etc…) rather than accumulation of knowledge.

And it is even difficult to say what happens within the consultation room, because the conversation doesn’t follow the standard of a dialogue. There is not a teaching to transfer, or no irrational belief to correct. Even though psychoanalysis has been named “talking cure”, it is actually and first of all a listening cure. The listening is in foreground; but a different listening, which is not just hearing. It is a listening that aims at the misunderstanding, because the misunderstanding indicates that another meaning is possible; it shows that another direction is possible. Indeed, words carry much more than it seems. So, the psychoanalyst will try to listen that other meaning that possibly arise from the words of the analysand, rather than trying to get his/her intended meaning.

Psychoanalysis is not psychology, psychotherapy, or medicine. Part 1/3

Psychoanalysis is an art of listening, and as such it can be at the same time either the easiest or the most difficult occupation. I studied clinical psychology at the University. Together with medicine, it was the only accepted degree for becoming a therapist later (not a psychoanalyst). However, psychology and philosophy sounded more interesting than medicine. At least, their declared interest for humankind seemed more straightforward than medicine. On the other hand, the weak scientism, the rationalism and materialism of medicine seemed to me a rough and presumptuous oversimplification. Such aridity, then, is what often times opens the door to spirituality, as a sort of compensation. Materialism on one hand, and spirituality on the other hand. It is the effect of the split between body and mind.

What I realized only later, as a psychology student and at the same time as analysand, is that also psychology and philosophy are very different from psychoanalysis. The first, psychology, suffers of a dangerous complex of inferiority to medicine, and just tries to emulate it. Not surprisingly, this way is leading nowhere. The second, philosophy, is a sophisticated practice of thinking. But Freud showed effectively that thinking is just the top of the iceberg, the small part that we see up the level of the water. But the important part is down there. But philosophy is all about thinking, reasoning, or (but it is just the other side of the coin) repressing or suspending the thinking (meditation). Even the most developed phenomenologies remain simply at the level of the thinking. As such, they aim to produce a universal and sharable knowledge.

Both psychology and philosophy do not recognize the unconscious. Both elude the listening. Even though both psychology and philosophy apparently emphasize the question, and the questioning, finally they just aim at producing answers and delivering teachings. The questioning in psychology and philosophy is the at best a maieutics, a method for guiding the other to a truth that is already written. Indeed, this is not a listening that opens to anything new; this is simply finding confirmation for what has already been said.

Despite many medical doctors claim that psychoanalysis should be accessible only to them (meaning with this that psychology, psychotherapy, or even psychoanalysis are branches of medicine), psychoanalysis lies at the antipodes of medicine too, for several reasons. Medicine (just as psychology and psychotherapy) is more likely in search of a universal knowledge, what is true for all.

The symptom, in medicine, is intended as a malfunctioning. Thus, medicine and aims at curing the symptom (more likely erasing it). Instead, in psychoanalysis there is a different conception of the symptom, which is not at all intended as a malfunctioning. For Freud the symptom was like a text that the person cannot read anymore. It was like having a text in an unknown language. At the beginning, Freud was thinking that the work of analysis was to give interpretations, so to finally discover the meaning of this unknown text. However, later became clear to Freud that the working through of the analysis was not that simple, and that a first version of the text was probably not even available. The symptom is likely impossible to understand once for all. But what is important is that Freud, for the first time, didn’t treat the symptom as something external to the client. Instead, he investigated the relations of a person with his symptoms, showing that the symptom has a particular place in our psychic economy. The symptom serves for something. At the same time, it is an attempt of self-healing, and something that provide a secondary satisfaction. Freud defined the symptom (and all the forgetfulness, the lapse, the dreams, the slips of tongue, etc…) as a compromise formation between different instances.

So, we see that the work of psychoanalysis is much more complex than in medicine. In medicine we think that we know what a body is. In western medicine there is a clear distinction between the body and the mind. For instance, the body of the western medicine is normally seen as a passive body. It is the body that lies on the bed (from which the etymology of the word clinic). Actually, this ideology is shared by psychology and psychotherapy, which consider the symptom as a cognitive or physical impairment that has nothing to do with the person who owns it. To such practices the symptom simply makes no sense. Thus, their goal is to get rid of it, and free the person by such scrap.

Instead, psychoanalysis starts from here. In psychoanalysis there is no waste, so the symptom has a completely different relevance. The symptoms speaks about the subject. It is the particular modality of enjoyment of a subject.

 Freud has shown is that there is an unconscious. And the unconscious is not stupid, or damaged. Then, rather than being worried to fix the symptom, what we first need to do is to read the symptom differently, and try to question that symptom. To be precise, symptoms are not accidental: the symptom is inscribed in a particular unconscious logic. What psychoanalysis always shows is that we are always somehow implicated in what happen to us. So, the symptom always talks about us, and what we should do is to listen to this symptom. The symptom has some specific ways for emerge; however, we can find it structured in a discourse (where for discourse we intend a fixation of the speech). Indeed, the symptom can become the most powerful resource for us.

 

Is Psychoanalysis missing from counseling in Hong Kong?

在香港的心理輔導中，心理分析是否遺漏了呢?


The following is the abstract of the research that I have carried out in Hong Kong in last years. A few words to sum up a long and complex work. An appetizer.
The research concerns the fact that psychoanalysis is quite marginal in Hong Kong; not only in the consultation room, but it remains unknown to the majority of people. Why? How can Hong Kong be so indifferent to psychoanalysis? A long journey has started from such questions...
 

 Abstract

While psychoanalysis has raised much interest in Mainland China and Taiwan, it remains marginally relevant in Hong Kong as evidenced by the paucity of literature available. This study aims to explore what hinders the reception and practice of psychoanalysis in the context of Hong Kong, and how local counselors listen to their clients. It was not assumed in this study that psychoanalysis is simply missing from Hong Kong. On the contrary, some aspects of psychoanalysis are considered to be embedded in the attitude of the local counselors, even if they do not expressly refer to psychoanalysis. 

For the purpose of this study, psychoanalysis has been reconsidered and operationalized in terms of a distinctive kind of listening. It is proposed that psychoanalytic listening is what best describes the essence of psychoanalysis. At the same time, because this refers to a practice rather than a theoretical definition, it is inclusive of the different orientations and schools in psychoanalysis and is capable of being distinguished from other counseling orientations. Furthermore, investigating the listening, rather than remaining at the theoretical level, allows one to investigate and compare different realities in which the psychoanalytic theory is absent. Indeed, psychoanalytic listening seems the most flexible yet comprehensive concept. 

The main research tool for this study is a 177-item questionnaire, developed and validated by the researcher. A total of four scales were developed. The psychoanalytic listening scale, and counseling listening scale, consisting of 4 subscales each, measured the listening profiles of counselors. A third scale, called Combining Theories, was developed for assessing the counselors’ attitude toward eclecticism and integration. Finally, a fourth scale with 6 sub-dimensions, called Criticalities against psychoanalysis, was developed for assessing the factors which hinder the development of psychoanalysis in Hong Kong.

Given the low popularity of psychoanalytic theory among Hong Kong counselors, it was expected their listening attitude would be largely inclined toward counseling listening. On the contrary, results showed a mixed listening profile, not completely distant from a psychoanalytic attitude. In particular, dimensions of transference and the floating attention emerged. Thus, it cannot be concluded that psychoanalysis is completely missing from Hong Kong. Instead, what is lacking is a conception of the unconscious. This is apparently the greatest limitation for the understanding and the reception of psychoanalysis in Hong Kong today. Indeed, the unconscious is a difficult concept to render in Chinese culture and language. Such difficulties in translating (or re-inventing) the unconscious in Chinese may indicate that the unconscious is perceived as something intangible, and impractical. 

The results of this study suggest there is at least an openness to and significant interest towards psychoanalytic theory. It was demonstrated that counselors do not perceive it as less effective or less developed than other approaches. Rather counselors considered it as a complex theory, requiring lengthy training. However, because psychoanalysis training opportunities are currently lacking, counselors are reluctant to adopt it. If given the opportunity, counselors would pursue further training. Chinese culture and values were not perceived to hinder the adoption of psychoanalysis. A strong attitude toward eclecticism is what influences how theories are understood and received by the Chinese, which is argued to be one factor affecting the reception of psychoanalysis. 

Another finding from this study is that while European and American cultures are more speaking oriented, Hong Kong Chinese culture is more listening oriented. This has important consequences not only for understanding ways to bring the practice of psychoanalysis to greater prominence in Hong Kong, but may also promote reinvention of psychoanalysis in the West.

The psychoanalytic listening and the counseling listening (part 1)

Introduction

The idea undergoing this article is that psychoanalysis is first of all a peculiar listening disposition. Today we probably have a vast array of talking cures (talking cure is how one of the first patients of Freud has described psychoanalysis), but what differentiates psychoanalysis from any other psychotherapeutic or counselling approach is a particular and distinctive listening. From a theoretical perspective, it is probably not possible to identify common grounds between different psychoanalytic schools; however, it is probably still possible to describe a psychoanalytic listening that is shared by majority of psychoanalysts. Despite listening is at the base of a clinical practice, it has not been always stressed enough. However, a distinctive psychoanalytic listening is particularly clear when compared to any listening in counselling and psychotherapy. Indeed, the last part of this chapter will analyze the premises of listening in counselling. 

The analytic attitude: a different listening disposition

What is the specific of psychoanalysis, and how does it work? Some scholars (Kernberg, 1993, 2001; White, 2001) have tried to describe the convergences and the divergences between some schools inside the psychoanalytic movement. Wallerstein (1991) tried to find the so called “common ground” among different psychoanalytic orientations; however as Green (2005) replied, this probably remains a wishful thinking impossible to realize. Furthermore, the adoption of a theoretical position does not guarantee the results of a practice, which is probably depending by other factors like the transference, rather than the analyst formation and his supposed knowledge or expertise. Instead, is it possible to describe psychoanalysis not just as a sum of concepts, but as a practice? What are the distinctive traits of psychoanalysis; and what are the basic assumptions that lead the analysts to assume a particular attitude or disposition when listen to their clients? While concepts may be specific of one school only, if a psychoanalytic attitude exists, it should be inclusive of different schools and orientations; and at the same time it should distinguish psychoanalysis from other disciplines.

Probably, what better describes a psychoanalytic attitude (differentiating at the same time psychoanalysis from other practices) is a peculiar and distinctive type of listening. The analytic listening is influenced by the theory, but is also a different disposition toward the speech. Indeed, if psychoanalysis is a talking cure, than listening cannot be less important. But very few scholars have emphasized this dimension. 

Listening as emerged by Freud’s recommendations

In 1912 Freud writes the “Recommendations to Physicians Practicing Psychoanalysis”, in which he lists a number of technical rules that might help analysts to conduct the process of analysis:

1.                  The first technique, Freud (1912) says, is a simple one, and consists in “not directing one's notice to anything in particular and in maintaining the same ‘evenly-suspended attention’“ (p.110). This is simply the counterpart to the demand made to the patient to obey to the fundamental rule of the free association. “The rule for the doctor may be expressed: ‘He should withhold all conscious influences from his capacity to attend, and give himself over completely to his “unconscious memory”.’ Or, to put it purely in terms of technique: ‘He should simply listen, and not bother about whether he is keeping anything in mind.’” (p.111).

2.                  A second advice is to avoid taking notes during analytical sessions, because “a detrimental selection from the material will necessarily be made as one writes the notes or shorthand, and part of one's own mental activity is tied up in this way, which would be better employed in interpreting what one has heard.” (p.112).

3.                  A third advice concerns is for the analyst to maintain emotional coldness, for creating the optimal condition for both parties. Freud advices analysts to put apart any therapeutic ambition and instead be content to operate as a surgeon who “puts aside all his feelings, even his human sympathy, and concentrates his mental forces on the single aim of performing the operation as skilfully as possible.” (p.114).

4.                  The analyst should do everything not to become a censorship of his own in selecting the patient’s material. “To put it in a formula: he must turn his own unconscious like a receptive organ towards the transmitting unconscious of the patient. He must adjust himself to the patient as a telephone receiver is adjusted to the transmitting microphone. Just as the receiver converts back into sound waves the electric oscillations in the telephone line which were set up by sound waves, so the doctor's unconscious is able, from the derivatives of the unconscious which are communicated to him, to reconstruct that unconscious, which has determined the patient's free associations.” (pp. 114-115).

5.                  “Educative ambition is of as little use as therapeutic ambition.” Every doctor should “take the patient’s capacities rather than his own desires as guide.” (p.118)

6.                  Patient’s intellectual cooperation: “mental activities such as thinking something over or concentrating the attention solve none of the riddles of a neurosis; that can only be done by patiently obeying the psycho-analytic rule, which enjoins the exclusion of all criticism of the unconscious or of its derivatives. One must be especially unyielding about obedience to that rule with patients who practise the art of sheering off into intellectual discussion during their treatment, who speculate a great deal and often very wisely about their condition and in that way avoid doing anything to overcome it.” (p.118).

Psychoanalysis emphasizes listening critically, listening with intelligence; not just “hearing”. In that essay “he was advising against various determined efforts to remember and was urging an unbiased, open-minded listening to everything the patient had to say. He explicitly indicated that the psychoanalyst would thus remember more and with less intrusion of bias, and he implicitly indicated that such a way of listening would lead to the psychoanalyst hearing more” (Jackson, 1992, p.1626). Listening with free floating attention goes beyond the plan of the explicit meaning, the reasoning, the rational thinking. Indeed, it is not easy to reach a condition of evenly suspended attention: it requires a continuous practice. So, Psychoanalysis is a priority, not a part time occupation. Psychoanalysis is an attitude toward life: it is the way we write, create, and invent life. It is creativity, and critical attitude. It is giving nothing for granted. Psychoanalysis is not a method for solving the crisis; on the opposite, it is how we question the crisis, and go through it.