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American Imago 63.2 (2006) 223-226

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Clinician's Corner

5225 Connecticut Avenue
Washington, D.C. 20015

Struggling to Hear

Inevitably, I look back all the way to the start, to my first day of psychiatric residency when, totally green and feeling lost, I was given the names of a dozen patients for whose therapy I now was responsible. Bewildered, I turned to a new co-resident, an older woman who had left her pediatric practice to learn child therapy and who herself was assigned a dozen child patients.

She was less confused than outraged. She stormed into the head of the department's office to confront the man at the top. How dare he assign patients the first day, before any of us had any idea of what we were supposed to do? These children were real people. She was willing to work hard, but patients could not be assigned to her until we had been taught how to do therapy.

The chief thought for a moment, then leaned forward and answered in a candid tone. "I'll tell you the truth," he said. "We wanted Anna Freud, but she's busy."

So we have to figure it out. We read, we study, we get supervision—but in the end, the essential responsibility for on-the-job training remains our own.

Over the decades I have been privileged here and in Europe to take part in many dozens of clinical study groups. I have been among the yeomen, arguing and learning with them, and I have been with the supposed immortals. And my early impression has only solidified through the years. It is that beneath the intense disputes over dynamics and technique lies the underlying question over which those battles are fought, the question of what an analysis is, what an analyst is trying to do.

Answer that and questions of technique become merely logical, because technique is attitude actualized. What makes [End Page 223] an attitude uniquely psychoanalytic is concern for the power of unconscious forces, the analyst's working in the service of helping the patient come to know his or her own mind with ruthless candor, unfettered by shame or guilt.

So a serious analyst analyzes in order to learn how to analyze. I shall not tax your patience by reviewing what I have found as I have tried to make sense of these, our common questions. But I do emphasize the theme at the basis of our work—and that is the analyst's working in the service of the other. That seemingly obvious phrase, in the service of the other, is deceptively simple. It is profound in its implications.

The fundamental principle from which all other principles of technique derive is regard for otherness, the analyst's profound and genuine respect from the marrow for the authenticity of the patient's self as a unique other, a singular other's self as valid as the analyst's own. Yes, regard implies witnessing, but it includes much more—how one sees an other, how one cares, how one recognizes, in short, how one regards.

Sadly, one of the most insidious occupational hazards of doing analytic work is the analyst's coming to believe that she or he could live the patient's life better than the patient can. The analyst is a translator, and the translator has no right to determine how the patient-author unfolds that story, not even what ending the author chooses. The analyst's responsibility to question never diminishes the patient's full right to unique personal answers.

It is a great privilege we share, that of being welcomed into the intimacy of another person's most private life. It is good to remember what trust and what courage it takes to be an analytic patient! We must be faithful to that trust as we work in the service of the other.

Which leads me to a second professional hazard, that having to do with the misuse of theory. Theory informs us; it teaches us to look for important matters we...


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