On Being Human in Psychotherapy

Dr. Klein, 1/28/2018

Something that consistently strikes me when I speak with patients for five minutes or five years in therapy or psychoanalysis is the sense of innate albeit unformulated or pre-reflective, original knowledge of organizing principles people have of themselves. There was a renown psychoanalyst in San Francisco, Joseph Weiss, who began to see that people had unconscious plans for how they needed to develop in therapy, and that therapists generally did better work if they were able to be sensitive and responsive to the complexities of those plans.

Take, for example, a person who has been treated by her parents while growing up as someone who was somehow always doing something wrong, and made to feel shameful about strivings to be independent. I use the phrase “made to feel” because relationships organize psychic structures, especially when we are young. If this person entered into therapy, the therapist might find that she is generally retiring and shy, with moments of brashness or subtle attempts to push back and to not be such a good girl, as it were.

Perhaps she misses a session out of the blue, lapses on her payment, or tells the therapist something factually inaccurate in her recounting of an interaction they had sessions back. These may all be unconscious tests used to determine whether she can safely utilize the therapist for her development through her earliest and most vital goals….the development of an autonomous and non-shameful sense of herself where she can be separate and imperfect while remaining accepted and loved. Does the therapist fail, or pass, or a combination of the two? What does the therapist bring in from her or his personal development that affects the responsiveness to these encounters? And, how do the two people talk about such complex unfolding processes? Well, it depends! It depends on how the two relate, how safe each feel with one another to be bold and vulnerable, and how the therapist may even fail these tests but remain helpful through admitting the failures; in so doing provide a new relational experience for the patient.

Perhaps when the patient missed that random session the therapist asks about it, or doesn’t at all. Not even talking about it may be helpful for this person or may indicate a shame-inducing response from the therapist. It’s impossible to tell in a hypothetical. The patient’s affect, her emotional expressions tied to verbalized content is the best path to intuiting what may bear the most fruit to inquire about. Perhaps the therapist makes a supportive interpretation, “I can imagine that missing the session may be hard for you to talk about, as you were made to feel guilty about being separate or imperfect growing up.” In making such a statement the therapist is demonstrating a willingness to venture forth and talk about that which has been buried, is being vulnerable in positing something without necessarily requiring the patient to go first, and is also presenting the statement tentatively – leaving room for the patient to correct the record. Again, these are all things she may not have been afforded in her development.

Now, if the therapist were to shame the patient by reminding her that missed sessions carry a fee (I trust that people to know this on their own and do not need reminding) or appears stern and clearly brittle, the patient may become less bold and daring in her attempts to continue her development of autonomy and independence, at least with that therapist at that time, because she would intuit that those aspirations are not welcomed. Or, if the therapist fails as first, the patient becomes introverted, and then the therapist notices this change in emotional expression and says “You know, I think I was a bit shaming there about the missed session. I didn’t mean to be, but I think I missed the point of the missed session for you. You are trying your best to find out if you can be imperfect for me, and if you can do things that are not necessarily pleasing for me and whether I will still be here for you without shaming you like your mother and father did when you were not perfect or submissive for them. Is that somewhere close to what just happened between us?” In this way the therapist can both fail and pass, and that redemptive combination can be even more powerful in terms of growth for both the patient and the analytic couple than anything.

This way of working rests on the assumption that people have internal working models of relationships; of self-concepts that are implicitly incorporated from their life development. Some of these are painful and people are trying to find the safest ways possible to change these so-called pathogenic beliefs. "Safe" here means the best chance of surveying whether one can move a little in the direction that they both crave and fear without eliciting the familiar painful reactions that were experienced from parents, siblings, spouses, and now from themselves.

The reason this approach is somewhat unique, is that is places affectivity (emotional resonance within and between people) as the prime element of internal and interpersonal worlds of experience. Classical analysts and the cadre of what are known as ego-psychologists believe the prime motivators of human volition are sexual and aggressive drives that operate as internal and energic. I disagree, although I do believe those impulses are importantly involved in human experiences in some way that is uniquely determined by each person.  Other schools of analysis have adopted some sensitivity to an interpersonal or contextual world. Cognitive Behavioral Therapists don’t acknowledge any complex worlds of experience based in contextual development at all! They simply believe that you have illogical thoughts, and that you need to learn more logical thoughts! Try telling that to a young attorney who grew up with an abusive father who screamed at him and threatened him. Try telling him that the anxiety that he feels when he goes up against the opposing counsel in trial is just “irrational” and that he should just remember everything will work out fine.

Another reason my approach is somewhat unique is that it imbues human life with a core sense of non-verbalized or non-conscious or pre-reflective knowledge about oneself. I believe, and Joseph Weiss’s research provided empirical support for the notion that people come in to therapy with unconscious tests they need to work through with the therapist, and that the therapist would do best by the patient by trying to help notice and articulate the meaningfulness of those beliefs and tests as they are unfolding, without engaging with the patient as if there is something wrong with them for trying to use us for an unmet developmental need.

Thanks for reading my post. I am very happy to be getting to know the people of Portland, Oregon, and I hope you will consider me as a contributing member of the community.

Sincerely,

Lucas A. Klein, Ph.D.

Appointments: (503) 208-7881

NW and SW Downtown Portland.