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185 Chapter 5 The Middle Phase and Termination: Multiplicity in Action It is a very remarkable thing that the Unconscious of one human being can react upon that of another, without passing through the Conscious.This deserves closer investigation, especially with a view to finding out whether preconscious activity can be excluded as playing a part in it; but, descriptively speaking, the fact is incontestable. —Sigmund Freud, “The Unconscious”1 Empathy: Human Beings Are Intrinsically Relational The foundation for all effective therapeutic work is empathy.2 Rather than a classical analytical “blank screen,”3 it is important for the therapist to be warm and genuine and to have “unconditional positive regard” for the patient (though not necessarily for everything the patient says or does). The therapist offers an honest, deeply human presence. In this sense, Carl Rogers’s view of empathic relationship is the basis for therapy: “It is the quality of the interpersonal encounter with the patient which is the most significant element in determining effectiveness.”4 This is echoed as a tenet of existential therapy as well: “It is the relationship that heals.”5 The therapist genuinely cares about the well-being of the patient as his or her first priority. Therapeutic “neutrality” is important, but it is not the same thing as being a “blank screen.” It does not mean coldness, aloofness, or lack of engagement. Sigmund Freud’s famous recommendation that the therapist exercise surgical coldness6 was written in the context of his anxiety about the dangers of erotic transference and countertransference, and there is ample evidence that he himself did not often adhere to it.7 Neutrality does mean refraining from bringing a specific or judgment-laden agenda for the patient’s life. In some sense, neutrality even resembles Rogers’s “nonpossessive caring.”8 The therapist does not need the patient to be a certain way or to please him or her. The therapist’s focus is on the patient’s needs, not his or her own. Neutrality also means reserving judgment about what one part of the patient may be expressing, recognizing that other parts may have very different views or experiences. Even when the “parts” of a person were conceived simply in terms of id, ego, and superego, Anna Freud defined neutrality as maintaining equidistance from these “institutions of the mind,” and also external reality.9 This is all the more crucial 186 MANY VOICES in light of contemporary formulations in which each self is even more multiplyconceived , and whatever is coming up in the present moment is more reflective of the particular interaction of the patient’s inner objects with the therapist’s, than a single, global “truth” that requires definitive interpretation. Abstinence is a related principle, classically defined as “refraining from gratifying the patient’s transference wishes”10 or desires. There is obviously always going to be some gratification for both: for the patient, simply in being listened to empathically and nonjudgmentally, and for the therapist, in offering something of value. A complete absence of any expression of care for the patient would probably end in rapid termination! I understand abstinence not at all as withholding of warmth but as an attitude of quiet expectancy, in which one refrains from making too much noise or being too active in order to make room for whatever the many parts of the patient might want to come out and say or do. Especially with regard to enactments, abstinence suggests a value for reflection over action that can be very important when the multiple meanings of a potential pull to act are not yet even minimally understood psychodynamically. More will be said about enactments below. The important thing to remember is that genuine empathy usually does not mean more activity on the part of the therapist but, rather, more attunement to what is occurring in the transference-countertransference continuum. Psychiatrist Howard E. Book has written: What one understands of a patient’s internal experience and how one uses (or chooses not to use) that understanding are quite different. A test of successfully being this is the extent to which the therapist’s responses stimulate and deepen the patient’s narrative flow . . . Put another way, empathy is being able to finish a patient’s sentence. Being empathic, though, is not finishing that sentence. Having one’s sentence finished is seldom experienced as being understood or comforted, but, rather, is experienced as intrusive and infantilizing.11 There is some agreement between the use of the term...

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