martedì 6 gennaio 2015

Psychoanalytic Listening: where theory and practice merge

Listening as the Core of Psychoanalysis 
To date, previous attempts to describe theoretical common grounds among psychoanalysts have been unsuccessful. Instead, it is here 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 majority of 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.

  Listening in Freud and after
In 1912 Freud wrote the seminal text Recommendations to Physicians Practicing Psychoanalysis in which he listed a number of technical rules for conducting psychoanalysis. First, “not directing one's notice to anything in particular and in maintaining the same ‘evenly-suspended attention’” (Freud, 1912, p.110) is the counterpart to the demand made to the patient to obey to the fundamental rule of the free association. Second, he noted that the analyst should maintain emotional coldness “and concentrate his mental forces on the single aim of performing the operation as skillfully as possible.” (p.114). Third, the analyst should do everything not to become a censorship of his own in selecting the patient’s material (metaphor of the receiver).

A more extensive literature review about psychoanalytic listening indicates that:
        a) while hearing is directed toward what is being said, listening is directed toward what is not being said;
        b) there is speech beyond the speaker and his/her intended meaning, and this ‘beyond area’ should be the focus of the analyst;
        c) the analyst listens what remains implicit and what is not being verbalized, including his/her feelings and reactions toward the client;
        d) psychoanalytic listening is not intentional, the patient is required to free associate and say whatever comes to mind, while the analyst is required not to focus on anything in particular;
        e) listening and questioning are intertwined, and together they may lead to a different disposition that allows unconscious material to emerge;
        g) there is no dialogue in analysis, but instead, an asymmetrical conversation;
        h) the aim of the psychoanalytic conversation is to reflect to the analysand his/her speech;
        i) the content of communication should be read at the light of the transference between analyst and analysand;
        j) generally the analyst sits behind the analysand, so as to avoid eye contact and interfere as little as possible with the flow of the analysand, who instead lays on a couch;
        k) psychoanalysis is more effective when it sustains the formulation and the articulation of questions rather than the production of answers;
        l) the analyst’s engagement in the treatment is more important than the mastery of any techniques.

Towards a definition of psychoanalytic listening
What I propose here is a list of items that was determined by reviewing: a) existing literature describing the listening in psychoanalysis, and; b) existing literature describing the listening in other psychotherapeutic/counseling approaches. 
Items were generated based on their satisfaction with two criteria: 1) they should be applicable to psychoanalysis in a broad sense, meaning that they should reflect the similarities and commonalities among different orientations, and; 2) they should be able to draw a clear differentiation between psychoanalysis, and any other psychotherapeutic or counselling approaches.

Then, a total of 177 Hong Kong professionals were surveyed to develop and assess the scale’s internal psychometric properties. The factor analysis confirmed a clearly defined, simple unidimensional structure, with 8 items. The Cronbach alpha of this scale was α = .75 and thus was regarded as satisfactory.

Psychoanalytic Listening Scale (PLS)
1.         I let clients start talking from where s/he prefers
2.         When I listen to a client, I listen to ambiguity and contradictions in his/her speech, what potentially opens to another possible meaning
3.         I encourage clients to reflect and question his/her own words
4.       My feelings and reactions to clients are meaningful to understanding them and their treatment
5.       Therapy proceeds depending whether I am really engaged, more than for the other techniques that I master
6.         I help clients formulate new questions, rather than giving them answers
7.       I follow the client’s associations rather than trying to impose a direction to the helping process
8.         I encourage clients to keep their questions open-ended

All items were assessed on a 6-point Likert scale, ranging from 1 = strongly disagree to 6 = strongly agree.
Higher scores indicated that a therapist is able to suspend his/her attention and free his/her listening from any assumptions concerning the content and the meaning of the client’s speech, and follow the talking of the client instead.

These eight items represent a simple yet meaningful solution that has emerged from this study (supported by statistical procedures); however, there are also numerous ways for defining a psychoanalytic listening.