The Analyst’s Authenticity: “If You See Something, Say Something” George Goldstein1 and Jessica Y. Suzuki2 1 NYU Postdoctoral Program in Psychotherapy and Psychoanalysis and Westchester Center for the study of Psychoanalysis and Psychotherapy 2 Teachers College, Columbia University
The history of authenticity in psychoanalysis is as old as analysis itself, but the analyst’s authenticity in particular has become an increasingly important area of focus in recent decades. This article traces the development of conceptions of analytic authenticity and proposes that the analyst’s spontaneous verbalization of his or her unformulated experience in session can be a potent force in the course of an analysis. We acknowledge that although analytic authenticity can be a challenging ideal for the analyst to strive for, it contains the power to transform the experience of the patient and the analyst, as well as the meaning of their work together. Whether it comes in the form of an insight-oriented comment or a simple acknowledgment of things as they seem to be, a therapist’s willingness to speak aloud something that has lost its language is a powerful clinical phenomenon that transcends theoretical C 2015 Wiley Periodicals, Inc. J. Clin. Psychol.: In Session 71:451–456, 2015. orientation and modality.
A man comes in for a consult. He and I (senior author, GG, the source of all first person clinical accounts in this article) spend an hour together, talking about his life. When the hour ends, neither of us has a clue as to what ails him or why he came in to speak with me. As he prepares to leave, I tell him my fee. He reaches into his pocket, pulls out a roll of hundred dollar bills, and throws some on my chair, since we are now standing. I then hear myself say to him, “Did you think I was just another pretty face?” He blanches, sits down, and says to me, “How did you know?” “Know what?” I say, still not getting it. And he begins to tell me about his compulsive visits to prostitutes. In another session, a deadened and reclusive woman announces that she is going on vacation in her very depersonalized manner. She asks whether I will miss her while she’s gone. Without thinking, I respond, “More importantly, I miss you when you’re here!” In both of these instances, I found myself offering my patients an unrehearsed, spontaneous, unedited response. Furthermore, in each of these examples, I was narrating something about my direct, unformulated experience of them. I have found in my work that authenticity can be a potent force in the treatment room, offering a way to put into language dissociative experiences that have not yet found their way into the room. As challenging as it can be to bring true authenticity into our work with patients, it also brings a level of intensity and clarity to our work that is truly transformative. The notion of authenticity has a long history in psychoanalytic theory and practice, perhaps even before it was articulated as such (Thompson, 2006). In the early days of psychoanalysis, the patient’s authenticity, rather than that of the analyst, was the sole focus of treatment. Though Freud did not employ the term “authenticity,” the endeavor he proposed–making the unconscious conscious–can also be described as the work of helping patients learn to experience more authentic versions of themselves. Yet in this early formulation, the analyst’s work in session was primarily conceptualized–naively, perhaps–as presenting a “blank screen,” onto which the patient’s transferential patterns could be projected and then interpreted.
Portions of this paper are based on a presentation at the Suffolk Institute of Psychotherapy and Psychoanalysis (SIPP), Long Island, New York, May, 2014. Please address correspondence to: George Goldstein, Westchester Center for the study of Psychoanalysis and Psychotherapy, 468 Rosedale Ave., White Plains, NY, 10605. E-mail: [email protected] C 2015 Wiley Periodicals, Inc. JOURNAL OF CLINICAL PSYCHOLOGY: IN SESSION, Vol. 71(5), 451–456 (2015) Published online in Wiley Online Library (wileyonlinelibrary.com/journal/jclp). DOI: 10.1002/jclp.22181
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Given this focus, the task could take place independent of the social context of the work. It was assumed that the relationship between patient and analyst, the analyst’s personal characteristics, and the moment-to-moment interaction between the parties were all irrelevant to the unmasking of certain “truths” that needed to be made explicit. This allowed for very brief “didactic” analyses, for colleagues to analyze each other, for analysts to go on vacations with patients, and even for a father (Freud) to analyze a daughter (Anna). Somehow, social context–the relational field–was deemed irrelevant to the task. It wasn’t until 1925, with the publication of a monograph coauthored by two members of Freud’s inner circle (Ferenczi & Rank, 1925), that the person of the analyst and the analytic relationship began to find their way into the discussion of the nature of psychoanalytic process. Ferenczi more than Rank focused on little moments within the relationship that are worth noting. These ideas came to greater fruition in Ferenczi’s (1933) seminal paper, Confusion of Tongues, in which he argued that it was the analyst’s attitude toward the patient, and his openness to discussing it directly in the work, that was curative. According to Aron and Regan (1993): [Ferenczi] discovered that the typical posture of analysts toward their patients repeated elements of the parent-child relationship that had led to the patients’ illness. Ferenczi saw the polite aloofness of the analyst as a form of professional hypocrisy [“inauthenticity”] that kept both the patient’s criticism of the analyst repressed and the analyst’s true feelings toward the patient masked, although nevertheless felt by the patient. The analyst’s emotional inaccessibility and insincerity repeated that of the traumatized patient’s parents. The trauma could not be worked through unless the patient reworked it in a relationship in which he or she was confident of the other’s emotional honesty, sincerity and accessibility. In Ferenczi’s (1933) view, it was this confidence in the fundamental honesty of the relationship that constituted the curative difference between the present and the traumatic past. (pp. 217–218) Although Ferenczi never used the term authenticity either, it seems he was attempting to convey just that idea. It is the patient’s confidence–or lack thereof–in the fundamental honesty of the relationship that constitutes the curative difference. Much of what was to become central to the Interpersonal and Relational schools of psychoanalysis is anticipated in these early works. In the decades to come, psychoanalytic theory developed an ever-increasing awareness of the analyst’s effect directly on the patient and the course of the analysis, and the analyst’s authenticity assumed an increasingly central role in understanding the therapeutic relationship. From Winnicott’s (1955) false self to Rogers’ (1957) notion of congruence as an essential facilitative condition in the therapy relationship, and beyond to the relational movement as a whole (Hirsch, 2011, 2014), genuineness on the part of both the patient and the therapist has become an explicit goal of the psychoanalytic endeavor. Though this value has attained its clearest expression in the writings of relational and humanistic theorists, an appreciation of the importance of authenticity transcends theoretical orientation and modality (Blanco, Muro, & Stickley, 2014; Jung, Wiesjahn, Rief, & Lincoln, 2014; Wogan & Norcross, 1985). Wolstein’s (1983) concept of the “first personal” offered an important addition to this developing line of thought. He argued that patients are in search of an “honest narrator,” someone who can react and respond from the center of his or her own experience directly, sincerely, and with a sense of immediacy. An analyst’s authentic response, in this view, means not attempting to gauge a reaction or filter a response; it means too that that the analyst trusts that he or she is responding to something worth noting, even if he or she is unclear about what that might be in the moment. This is reminiscent of Fromm’s (1955) idea of core-to-core relatedness–that patient and therapist can achieve a profound connectedness at a core level that transcends their external differences. If we are not so focused on predetermining who we think we are supposed to be, or whom we think the patient needs us to be, then we may surprise ourselves. And in the process, our patients will find us, or we will find them. It is part of the analytic task to construct an environment with patients where a different kind of relating may be possible, where two people might find a way to talk directly to each other,
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absent guile, in a good faith attempt to get to know something as it truly is and not as we may wish it to be. Often, that may require the analyst to go first, so to speak, by being his or her authentic self. This does not mean that each session, or even many sessions, has moments like these. Analytic work is often slow and painstaking. However, these moments do occur, and when they do we should understand what is at stake. When we are prepared to speak from our own center, we can trust that we are onto something. What a gift, it seems, to be able to talk about one’s life with an honest narrator who can access and deliver this truth. It is a rare experience indeed to feel cherished and valued in this way. As analysts, we may feel disappointment in ourselves when we notice how challenging it often is to be that authentic with ourselves and our patients. Singer (1968), in his explication of the analyst’s reluctance to interpret, offers some potent observations about why it may be difficult to do so. Beyond the fear–misplaced, according to Singer–that the therapist’s observations may be wrong, or ill-timed, or accurate but harmful, there lies the reality that any penetrating insight offered by the therapist into the patient’s situation says at least as much about the therapist as it does about the patient. As Singer puts it: “It takes one to know one, and in his correct interpretation the therapist reveals that he is one” (p. 369). Perhaps for this reason, the clinical literature on authenticity and congruence deals quite a bit with the overlapping construct of therapist self-disclosure. Though self-disclosure is indeed a rich potential source of genuineness in the therapy relationship, the focus here is on a narrower slice of this construct, what Knox and Hill (2003) call “disclosures of immediacy,” which reveal therapists’ here-and-now reactions to what is going on in the moment. These types of disclosures are somewhat different from the explicit sharing of the therapist’s personal details in that their value lies not in their content but in the fact that the therapist is offering something present, responsive, and real (Miller et al., 1999). Thus, therapist authenticity seems to depend on his or her ability to be creative, spontaneous, and attuned to what the patient is offering (Schnelbacher & Leijssen, 2009; Singer, 1968). My personal experience in these moments speaks to this truth: Very often, I do not remember thinking about my responses as much as they seemed to just present themselves. Being surprised by ourselves is often a sign of something authentic beginning to emerge. Appropriate for a paper on authenticity, I have an embarrassing memory to share: I was once sitting with a remarkably obsessional and frozen man, and in spite of great efforts on my part to pay attention—in fact, I rarely lose focus in a session––my mind had wandered, and I was lost in my own thoughts. My patient, who generally noticed nothing about others, says to me, “Where are you? Are you paying attention?” Oops!!! Clearly, I had not heard a thing for the last minute or two. I heard myself say, “I think you’re right; my mind was elsewhere.” The patient, to his credit, asked, “Where were you?” Sensing a shift in him, I decided to dive in. “Do you actually want to know?” I asked. “Yes,” he responded, so I told him, feeling quite embarrassed, “I was on the back nine of my favorite golf course.” He asked, “Was I really that boring?” and I responded by asking him if he had been at all interested in what he had been talking about. “Actually, not really,” he said. So I responded, “Since neither of us were interested in what you were talking about, why don’t you tell me what is it that you do want to say, that you’re not getting to? Let’s see what we’ve got,” which we then proceeded to do. Often, our spontaneous responses speak to a deeper truth, more akin to an interpretation; other times, they may be simply a verbalization of something plainly on the surface of things. I once made an appointment with a colleague who wanted a consult for herself. She was a few minutes late, and while waiting, I peered out the window and saw her dragging two garbage cans, left on my lawn, up to the side of my house before entering my waiting room. I was stunned watching all this unfold, not sure what I was actually observing or what meaning it might have for her or for us. She entered the consultation room, and we proceeded with a first session. Toward the end of the session I told her what I had observed and expressed my confusion and curiosity. What did she think this might be about? Her response was matter-of-fact: “It didn’t seem right to just walk past them. It seemed like the nice thing to do.” She seemed puzzled that I would take up her time with this silly discussion, wondering what my question could mean. I said that I was not yet sure but felt confident that it was important in ways that might become clearer as we went
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along. Over the next 6 months it became clearer to us both how she unconsciously organized her relationships in excessively accommodative, servile, and masochistic patterns, especially with men. Her presenting problem revealed a painful marriage in which she experienced herself as victim, as servant to a very demanding man, in fact her second such unhappy marriage. Levenson (1986) notes that despite our impulse to probe to ever-deeper levels of meaning, often the most meaningful and powerful data are “hidden” right under our nose. The banal details of a situation, identified and illuminated if the analyst remembers to be curious about them, are often the ones that tell us the most about the clinical picture. Opportunities for authenticity, it seems, can arise in the most ordinary of situations. Levenson, writing in the 1960s and 1970s, invoked the “Rumpelstiltskin Fallacy” of his time, in which psychoanalysts seemed to expect that simple interpretation would be enough to cure. In the fairytale narrative, of course, the magic spell is broken instantly once the name of the goblin is said aloud. Since then our field has made progress in our thinking about the analytic process, acknowledging that a multitude of other factors are required to potentiate insight and transformation in our patients. Interpretation, by itself, is not curative. Yet something about the metaphor of Rumpelstiltskin continues to resonate with my experience of authenticity in the treatment room. While naming the thing is in many ways only a starting point, there is nonetheless something about saying it aloud that changes the very nature of what is being examined. The phenomenon is related to Stern’s (2003) notion of unformulated experience, in that a new sense of meaning is constructed out of the interplay between patient and analyst, one that both reflects and transforms what existed before. As analysts, we attempt to make experience explicit. We give words to some aspect of experience that has lost its very language, and in so doing we help to create the possibility that its hold on the patient might somehow be changed. When we have the courage to simply say aloud what we see, magic can happen. As Levenson (1986) remarked (after Oscar Wilde), “Only superficial people insist on looking beneath the surface.” (pg. 487). Perhaps not surprisingly, the value of authenticity extends to the supervisory relationship as well. I recall yet another embarrassing experience from my time in a supervision group with the noted psychoanalyst Ben Wolstein and four or five colleagues. It was my turn to present a case. But before I began relating my session notes, I paused, and in great pain and hesitation, I said, “This was a difficult session. I think I said the dumbest thing one human being has ever said to another human being, and I am mortified.” Wolstein sat silently and then responded, “I’m sure it wasn’t that bad. Why don’t you tell us what took place?” I reluctantly did. Wolstein listened. He didn’t interrupt, asked no questions, and then said, “You know, you may have been right. That might be the dumbest thing anyone has ever said to a patient.” The group giggled; I winced, and then Wolstein said, “Listen, only you could’ve been that dumb. You got yourself boxed into a corner. I am not sure why that was, but you need to figure that out. This is going to happen over and over in your growth as an analyst. Make friends with it, don’t be so humiliated by it, and learn from your mistakes. There is more to be learned from our mistakes than by our successes.” He served it up straight, sincerely, and to great effect. It gave me an opportunity to look at the impasse and come away with something that has lasted these many years. How is it that experienced analysts of differing schools of thought seem to be capable of deep and profound work in spite of their metapsychological differences? It may be because those experienced analysts—or therapists from other theoretical orientations–reach a point in their careers where they are able to speak to their patients from a deeply committed and authentic place, with a great degree of comfort and earnestness and a substantial absence of anxiety and conflict. With a lifetime of work within their chosen metaphor or frame of reference, they come to trust their experience of themselves with another. Their metaphors may be different––metapsychologies are really more for the analyst than the patient––but they speak with conviction. That is, they command a certain attention that requires the patient to pay attention. This is not to minimize the importance of a metapsychology. I am as deeply partisan about the fundamental superiority of my metapsychology as any other analyst. But at the end of the day, it may be our ability to convey something authentic, more than the underlying theory that informs our communications, that captures a patient’s imagination. This “nondenominational”
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perspective on analytic work, exemplified in Sabert Basescu’s body of work (e.g., Basescu, 1990a, 1990b), holds that “the important thing about psychoanalysis is not the theory itself but rather an authentic and subjectively compelling relationship with the analyst, a place from which a patient can begin to let go of the constricting defenses constructed over a lifetime of self-protection” (Goldstein & Golden, 2010). It is also important to acknowledge that although the subject of authenticity is vital to an understanding of psychoanalytic work, it is only one of many factors that go into analytic thinking and practice. Sometimes when practitioners speak about psychoanalytic work, it can seem as if they are identifying a particular factor or topic as “the” key element that unlocks our understanding of human experience. Yet both common sense and empirical data argue for a richer and more complex reality in which multiple strands of technique, relationship, and context interact to shape the course of any given analysis. At the same time, paradoxically, our choice of what to emphasize often gives defining shape or meaning to our work. The psychotherapy research literature indicates that authenticity– defined alternately as “genuineness,” “congruence,” or “transparency”–significantly affects the strength of the therapeutic relationship and patient outcomes (Kolden, Klein, Wang, & Austin, 2011; Lambert, 1992); furthermore, that there is a strong clinical consensus on the value of authenticity across practitioners’ theoretical orientations (Wogan & Norcross, 1985). At the same time, a qualitative study of patients’ experiences in therapy (Schnellbacher & Leijssen, 2009) suggested that few patients define the analyst’s authenticity as the most important or curative factor in their analysis; in fact, many other factors have been identified as at least as important in determining therapeutic outcomes (e.g., Norcross & Lambert, 2011). As with so much else in psychoanalytic work, the particulars of the patient, the therapist, and their interaction necessarily guide our choices in the moment. Presumably, when one goes to art school one learns about all the elements of what goes into making art, be it a painting, a sculpture, or photograph. And so students learn about light, color, balance, perspective, shape, concept, and tension, among other artistic values and components. All art contains these elements–and yet all art is different depending on one’s commitment to any one particular element. Emphasizing color over perspective produces a very different canvas from emphasizing shape over perspective. No two canvases are the same, and different schools produce widely differing views of the perceived world. Picasso is not Monet, and Rodin is not Miro. The same is true in psychoanalysis; that is, all the elements need to be taught, and every analysis contains some part of all the essentials: history, insight, interpretation, inquiry, transference, countertransference, dreams, associations, conflicts, responsibility, and authenticity, among others. And yet where we make our commitment–where we place our emphasis–produces a very different canvas or experience. This may be hard to determine in any given session, but over time our analytic values define our work and separate us one from the other. In thinking about the value of analytic authenticity, I am reminded of an old George Burns comment: The secret to success in life is being sincere, and once you can fake that you’ve got it made. It’s a good line, and it may even be generally true, but not in the analytic office. As in art school, we as analysts need to learn all the basic elements that inform our craft. But make no mistake, an analyst’s (and arguably any therapist’s) values regarding issues such as authenticity will define the true nature of the treatment canvas.
Selected References and Recommended Readings Aron, L. & Ragen, T. (1993), Abandoned workings: Ferenczi’s mutual analysis. In L. Harris & A. Harris (Eds.), The Legacy of Sandor Ferenczi (pp. 217–226). Hillsdale, NJ: The Analytic Press. Basescu, S. (1990a). Show and tell. In G. Stricker & M. Fisher (Eds.), Self-disclosure in the therapeutic relationship (pp. 47–59). New York: Springer. Basescu, S. (1990b). Tools of the trade: The use of the self in psychotherapy. Group, 14(3), 157–165. Blanco, P. J., Muro, J. H., & Stickley, V. K. (2014). Understanding the concept of genuineness in play therapy: Implications for the supervision and teaching of beginning play therapists. International Journal of Play Therapy, 23(1), 44–54.
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Ferenczi, S. (1933). Confusion of the tongues between the adults and the child–(The language of tenderness and of passion). International Journal of Psychoanalysis, 30(4), 225–230. Ferenczi, S., & Rank, O. (1925). The development of psychoanalysis. Nervous and Mental Disease Monograph Series, No. 40. Washington, DC: Nervous and Mental Disease Publishing Co. Fromm, E. (1955). The Sane society. New York: Rinehart & Co. Goldstein, G., & Golden, H. (Eds.), (2010). Sabert Basescu: Selected papers on human nature and psychoanalysis (Vol. 42). London: Routledge. Hirsch, I. (2011). On some contributions of the Interpersonal psychoanalytic tradition to 21st-century psychoanalysis. Contemporary Psychoanalysis, 47, 561–570. Hirsch, I. (2014). The Interpersonal tradition: The origins of psychoanalytic subjectivity. London: Routledge. Jung, E., Wiesjahn, M., Rief, W., & Lincoln, T. M. (2014). Perceived therapist genuineneness predicts therapeutic alliance in cognitive behavioural therapy for psychosis. British Journal of Clinical Psychology. doi:10.1111/bjc.12059 Knox, S., & Hill, C. E. (2003). Therapist self-disclosure: Research-based suggestions for practitioners. Journal of Clinical Psychology: In Session, 59, 529–539. Kolden, G. G., Klein, M. H., Wang, C. C., & Austin, S. B. (2011). Congruence/genuineness. Psychotherapy, 48(1), 65–71. Lambert, M. J. (1992). Psychotherapy outcome research: Implications for integrative and eclectic therapists. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94–129). New York: Basic Books. Levenson, E. A. (1987). The purloined self. Journal of the American Academy of Psychoanalysis, 15, 481–490. Miller, J. B., Jordan, J. V., Stiver, I. P., Walker, M., Surrey, J. L., & Eldridge, N. S. (2004). Therapists’ authenticity. In J. V. Jordan, L. M. Hartling, & M. Walker (Eds.), The complexity of connection: Writings from the Stone Center’s Jean Baker Miller Training Institute (pp. 64–89). New York: Guilford Press. Norcross, J. C., & Lambert, M. J. (2011). Evidence-based therapy relationships. Psychotherapy relationships that work (2nd ed., pp. 3–21). New York: Oxford University Press. Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103. Schnellbacher, J., & Leijssen, M. (2008). The significance of therapist genuineness from the client’s perspective. Journal of Humanistic Psychology, 49(2), 207–228. Singer, E. (1968). The reluctance to interpret. In E. F. Hammer (Ed.), The use of interpretation in treatment (pp. 364–371). New York: Grune & Stratton. Stern, D. B. (2003). Unformulated experience: From dissociation to imagination in psychoanalysis. London: Routledge. Thompson, M. G. (2006). Vicissitudes of authenticity in the psychoanalytic situation. Contemporary Psychoanalysis, 42(2), 139–176. Winnicott, D. W. (1955). Metapsychological and clinical aspects of regression within the psychoanalytical set-up. The International Journal of Psychoanalysis. 36, 16–26. Wolstein, B. (1983). The first person in interpersonal relations. Contemporary Psychoanalysis, 19(3), 522– 535. Wogan, M., & Norcross, J. C. (1985). Dimensions of therapeutic skills and techniques: Empirical identification, therapist correlates, and predictive utility. Psychotherapy: Theory, Research, Practice, Training, 22(1), 63–74.
The history of authenticity in psychoanalysis is as old as analysis itself, but the analyst’s authenticity in particular has become an increasingly important area of focus in recent decades. This article traces the development of conceptions of analytic authenticity and proposes that the analyst’s spontaneous verbalization of his or her unformulated experience in session can be a potent force in the course of an analysis. We acknowledge that although analytic authenticity can be a challenging ideal for the analyst to strive for, it contains the power to transform the experience of the patient and the analyst, as well as the meaning of their work together. Whether it comes in the form of an insight-oriented comment or a simple acknowledgment of things as they seem to be, a therapist’s willingness to speak aloud something that has lost its language is a powerful clinical phenomenon that transcends theoretical C 2015 Wiley Periodicals, Inc. J. Clin. Psychol.: In Session 71:451–456, 2015. orientation and modality.
A man comes in for a consult. He and I (senior author, GG, the source of all first person clinical accounts in this article) spend an hour together, talking about his life. When the hour ends, neither of us has a clue as to what ails him or why he came in to speak with me. As he prepares to leave, I tell him my fee. He reaches into his pocket, pulls out a roll of hundred dollar bills, and throws some on my chair, since we are now standing. I then hear myself say to him, “Did you think I was just another pretty face?” He blanches, sits down, and says to me, “How did you know?” “Know what?” I say, still not getting it. And he begins to tell me about his compulsive visits to prostitutes. In another session, a deadened and reclusive woman announces that she is going on vacation in her very depersonalized manner. She asks whether I will miss her while she’s gone. Without thinking, I respond, “More importantly, I miss you when you’re here!” In both of these instances, I found myself offering my patients an unrehearsed, spontaneous, unedited response. Furthermore, in each of these examples, I was narrating something about my direct, unformulated experience of them. I have found in my work that authenticity can be a potent force in the treatment room, offering a way to put into language dissociative experiences that have not yet found their way into the room. As challenging as it can be to bring true authenticity into our work with patients, it also brings a level of intensity and clarity to our work that is truly transformative. The notion of authenticity has a long history in psychoanalytic theory and practice, perhaps even before it was articulated as such (Thompson, 2006). In the early days of psychoanalysis, the patient’s authenticity, rather than that of the analyst, was the sole focus of treatment. Though Freud did not employ the term “authenticity,” the endeavor he proposed–making the unconscious conscious–can also be described as the work of helping patients learn to experience more authentic versions of themselves. Yet in this early formulation, the analyst’s work in session was primarily conceptualized–naively, perhaps–as presenting a “blank screen,” onto which the patient’s transferential patterns could be projected and then interpreted.
Portions of this paper are based on a presentation at the Suffolk Institute of Psychotherapy and Psychoanalysis (SIPP), Long Island, New York, May, 2014. Please address correspondence to: George Goldstein, Westchester Center for the study of Psychoanalysis and Psychotherapy, 468 Rosedale Ave., White Plains, NY, 10605. E-mail: [email protected] C 2015 Wiley Periodicals, Inc. JOURNAL OF CLINICAL PSYCHOLOGY: IN SESSION, Vol. 71(5), 451–456 (2015) Published online in Wiley Online Library (wileyonlinelibrary.com/journal/jclp). DOI: 10.1002/jclp.22181
452
Journal of Clinical Psychology: In Session, May 2015
Given this focus, the task could take place independent of the social context of the work. It was assumed that the relationship between patient and analyst, the analyst’s personal characteristics, and the moment-to-moment interaction between the parties were all irrelevant to the unmasking of certain “truths” that needed to be made explicit. This allowed for very brief “didactic” analyses, for colleagues to analyze each other, for analysts to go on vacations with patients, and even for a father (Freud) to analyze a daughter (Anna). Somehow, social context–the relational field–was deemed irrelevant to the task. It wasn’t until 1925, with the publication of a monograph coauthored by two members of Freud’s inner circle (Ferenczi & Rank, 1925), that the person of the analyst and the analytic relationship began to find their way into the discussion of the nature of psychoanalytic process. Ferenczi more than Rank focused on little moments within the relationship that are worth noting. These ideas came to greater fruition in Ferenczi’s (1933) seminal paper, Confusion of Tongues, in which he argued that it was the analyst’s attitude toward the patient, and his openness to discussing it directly in the work, that was curative. According to Aron and Regan (1993): [Ferenczi] discovered that the typical posture of analysts toward their patients repeated elements of the parent-child relationship that had led to the patients’ illness. Ferenczi saw the polite aloofness of the analyst as a form of professional hypocrisy [“inauthenticity”] that kept both the patient’s criticism of the analyst repressed and the analyst’s true feelings toward the patient masked, although nevertheless felt by the patient. The analyst’s emotional inaccessibility and insincerity repeated that of the traumatized patient’s parents. The trauma could not be worked through unless the patient reworked it in a relationship in which he or she was confident of the other’s emotional honesty, sincerity and accessibility. In Ferenczi’s (1933) view, it was this confidence in the fundamental honesty of the relationship that constituted the curative difference between the present and the traumatic past. (pp. 217–218) Although Ferenczi never used the term authenticity either, it seems he was attempting to convey just that idea. It is the patient’s confidence–or lack thereof–in the fundamental honesty of the relationship that constitutes the curative difference. Much of what was to become central to the Interpersonal and Relational schools of psychoanalysis is anticipated in these early works. In the decades to come, psychoanalytic theory developed an ever-increasing awareness of the analyst’s effect directly on the patient and the course of the analysis, and the analyst’s authenticity assumed an increasingly central role in understanding the therapeutic relationship. From Winnicott’s (1955) false self to Rogers’ (1957) notion of congruence as an essential facilitative condition in the therapy relationship, and beyond to the relational movement as a whole (Hirsch, 2011, 2014), genuineness on the part of both the patient and the therapist has become an explicit goal of the psychoanalytic endeavor. Though this value has attained its clearest expression in the writings of relational and humanistic theorists, an appreciation of the importance of authenticity transcends theoretical orientation and modality (Blanco, Muro, & Stickley, 2014; Jung, Wiesjahn, Rief, & Lincoln, 2014; Wogan & Norcross, 1985). Wolstein’s (1983) concept of the “first personal” offered an important addition to this developing line of thought. He argued that patients are in search of an “honest narrator,” someone who can react and respond from the center of his or her own experience directly, sincerely, and with a sense of immediacy. An analyst’s authentic response, in this view, means not attempting to gauge a reaction or filter a response; it means too that that the analyst trusts that he or she is responding to something worth noting, even if he or she is unclear about what that might be in the moment. This is reminiscent of Fromm’s (1955) idea of core-to-core relatedness–that patient and therapist can achieve a profound connectedness at a core level that transcends their external differences. If we are not so focused on predetermining who we think we are supposed to be, or whom we think the patient needs us to be, then we may surprise ourselves. And in the process, our patients will find us, or we will find them. It is part of the analytic task to construct an environment with patients where a different kind of relating may be possible, where two people might find a way to talk directly to each other,
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absent guile, in a good faith attempt to get to know something as it truly is and not as we may wish it to be. Often, that may require the analyst to go first, so to speak, by being his or her authentic self. This does not mean that each session, or even many sessions, has moments like these. Analytic work is often slow and painstaking. However, these moments do occur, and when they do we should understand what is at stake. When we are prepared to speak from our own center, we can trust that we are onto something. What a gift, it seems, to be able to talk about one’s life with an honest narrator who can access and deliver this truth. It is a rare experience indeed to feel cherished and valued in this way. As analysts, we may feel disappointment in ourselves when we notice how challenging it often is to be that authentic with ourselves and our patients. Singer (1968), in his explication of the analyst’s reluctance to interpret, offers some potent observations about why it may be difficult to do so. Beyond the fear–misplaced, according to Singer–that the therapist’s observations may be wrong, or ill-timed, or accurate but harmful, there lies the reality that any penetrating insight offered by the therapist into the patient’s situation says at least as much about the therapist as it does about the patient. As Singer puts it: “It takes one to know one, and in his correct interpretation the therapist reveals that he is one” (p. 369). Perhaps for this reason, the clinical literature on authenticity and congruence deals quite a bit with the overlapping construct of therapist self-disclosure. Though self-disclosure is indeed a rich potential source of genuineness in the therapy relationship, the focus here is on a narrower slice of this construct, what Knox and Hill (2003) call “disclosures of immediacy,” which reveal therapists’ here-and-now reactions to what is going on in the moment. These types of disclosures are somewhat different from the explicit sharing of the therapist’s personal details in that their value lies not in their content but in the fact that the therapist is offering something present, responsive, and real (Miller et al., 1999). Thus, therapist authenticity seems to depend on his or her ability to be creative, spontaneous, and attuned to what the patient is offering (Schnelbacher & Leijssen, 2009; Singer, 1968). My personal experience in these moments speaks to this truth: Very often, I do not remember thinking about my responses as much as they seemed to just present themselves. Being surprised by ourselves is often a sign of something authentic beginning to emerge. Appropriate for a paper on authenticity, I have an embarrassing memory to share: I was once sitting with a remarkably obsessional and frozen man, and in spite of great efforts on my part to pay attention—in fact, I rarely lose focus in a session––my mind had wandered, and I was lost in my own thoughts. My patient, who generally noticed nothing about others, says to me, “Where are you? Are you paying attention?” Oops!!! Clearly, I had not heard a thing for the last minute or two. I heard myself say, “I think you’re right; my mind was elsewhere.” The patient, to his credit, asked, “Where were you?” Sensing a shift in him, I decided to dive in. “Do you actually want to know?” I asked. “Yes,” he responded, so I told him, feeling quite embarrassed, “I was on the back nine of my favorite golf course.” He asked, “Was I really that boring?” and I responded by asking him if he had been at all interested in what he had been talking about. “Actually, not really,” he said. So I responded, “Since neither of us were interested in what you were talking about, why don’t you tell me what is it that you do want to say, that you’re not getting to? Let’s see what we’ve got,” which we then proceeded to do. Often, our spontaneous responses speak to a deeper truth, more akin to an interpretation; other times, they may be simply a verbalization of something plainly on the surface of things. I once made an appointment with a colleague who wanted a consult for herself. She was a few minutes late, and while waiting, I peered out the window and saw her dragging two garbage cans, left on my lawn, up to the side of my house before entering my waiting room. I was stunned watching all this unfold, not sure what I was actually observing or what meaning it might have for her or for us. She entered the consultation room, and we proceeded with a first session. Toward the end of the session I told her what I had observed and expressed my confusion and curiosity. What did she think this might be about? Her response was matter-of-fact: “It didn’t seem right to just walk past them. It seemed like the nice thing to do.” She seemed puzzled that I would take up her time with this silly discussion, wondering what my question could mean. I said that I was not yet sure but felt confident that it was important in ways that might become clearer as we went
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along. Over the next 6 months it became clearer to us both how she unconsciously organized her relationships in excessively accommodative, servile, and masochistic patterns, especially with men. Her presenting problem revealed a painful marriage in which she experienced herself as victim, as servant to a very demanding man, in fact her second such unhappy marriage. Levenson (1986) notes that despite our impulse to probe to ever-deeper levels of meaning, often the most meaningful and powerful data are “hidden” right under our nose. The banal details of a situation, identified and illuminated if the analyst remembers to be curious about them, are often the ones that tell us the most about the clinical picture. Opportunities for authenticity, it seems, can arise in the most ordinary of situations. Levenson, writing in the 1960s and 1970s, invoked the “Rumpelstiltskin Fallacy” of his time, in which psychoanalysts seemed to expect that simple interpretation would be enough to cure. In the fairytale narrative, of course, the magic spell is broken instantly once the name of the goblin is said aloud. Since then our field has made progress in our thinking about the analytic process, acknowledging that a multitude of other factors are required to potentiate insight and transformation in our patients. Interpretation, by itself, is not curative. Yet something about the metaphor of Rumpelstiltskin continues to resonate with my experience of authenticity in the treatment room. While naming the thing is in many ways only a starting point, there is nonetheless something about saying it aloud that changes the very nature of what is being examined. The phenomenon is related to Stern’s (2003) notion of unformulated experience, in that a new sense of meaning is constructed out of the interplay between patient and analyst, one that both reflects and transforms what existed before. As analysts, we attempt to make experience explicit. We give words to some aspect of experience that has lost its very language, and in so doing we help to create the possibility that its hold on the patient might somehow be changed. When we have the courage to simply say aloud what we see, magic can happen. As Levenson (1986) remarked (after Oscar Wilde), “Only superficial people insist on looking beneath the surface.” (pg. 487). Perhaps not surprisingly, the value of authenticity extends to the supervisory relationship as well. I recall yet another embarrassing experience from my time in a supervision group with the noted psychoanalyst Ben Wolstein and four or five colleagues. It was my turn to present a case. But before I began relating my session notes, I paused, and in great pain and hesitation, I said, “This was a difficult session. I think I said the dumbest thing one human being has ever said to another human being, and I am mortified.” Wolstein sat silently and then responded, “I’m sure it wasn’t that bad. Why don’t you tell us what took place?” I reluctantly did. Wolstein listened. He didn’t interrupt, asked no questions, and then said, “You know, you may have been right. That might be the dumbest thing anyone has ever said to a patient.” The group giggled; I winced, and then Wolstein said, “Listen, only you could’ve been that dumb. You got yourself boxed into a corner. I am not sure why that was, but you need to figure that out. This is going to happen over and over in your growth as an analyst. Make friends with it, don’t be so humiliated by it, and learn from your mistakes. There is more to be learned from our mistakes than by our successes.” He served it up straight, sincerely, and to great effect. It gave me an opportunity to look at the impasse and come away with something that has lasted these many years. How is it that experienced analysts of differing schools of thought seem to be capable of deep and profound work in spite of their metapsychological differences? It may be because those experienced analysts—or therapists from other theoretical orientations–reach a point in their careers where they are able to speak to their patients from a deeply committed and authentic place, with a great degree of comfort and earnestness and a substantial absence of anxiety and conflict. With a lifetime of work within their chosen metaphor or frame of reference, they come to trust their experience of themselves with another. Their metaphors may be different––metapsychologies are really more for the analyst than the patient––but they speak with conviction. That is, they command a certain attention that requires the patient to pay attention. This is not to minimize the importance of a metapsychology. I am as deeply partisan about the fundamental superiority of my metapsychology as any other analyst. But at the end of the day, it may be our ability to convey something authentic, more than the underlying theory that informs our communications, that captures a patient’s imagination. This “nondenominational”
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perspective on analytic work, exemplified in Sabert Basescu’s body of work (e.g., Basescu, 1990a, 1990b), holds that “the important thing about psychoanalysis is not the theory itself but rather an authentic and subjectively compelling relationship with the analyst, a place from which a patient can begin to let go of the constricting defenses constructed over a lifetime of self-protection” (Goldstein & Golden, 2010). It is also important to acknowledge that although the subject of authenticity is vital to an understanding of psychoanalytic work, it is only one of many factors that go into analytic thinking and practice. Sometimes when practitioners speak about psychoanalytic work, it can seem as if they are identifying a particular factor or topic as “the” key element that unlocks our understanding of human experience. Yet both common sense and empirical data argue for a richer and more complex reality in which multiple strands of technique, relationship, and context interact to shape the course of any given analysis. At the same time, paradoxically, our choice of what to emphasize often gives defining shape or meaning to our work. The psychotherapy research literature indicates that authenticity– defined alternately as “genuineness,” “congruence,” or “transparency”–significantly affects the strength of the therapeutic relationship and patient outcomes (Kolden, Klein, Wang, & Austin, 2011; Lambert, 1992); furthermore, that there is a strong clinical consensus on the value of authenticity across practitioners’ theoretical orientations (Wogan & Norcross, 1985). At the same time, a qualitative study of patients’ experiences in therapy (Schnellbacher & Leijssen, 2009) suggested that few patients define the analyst’s authenticity as the most important or curative factor in their analysis; in fact, many other factors have been identified as at least as important in determining therapeutic outcomes (e.g., Norcross & Lambert, 2011). As with so much else in psychoanalytic work, the particulars of the patient, the therapist, and their interaction necessarily guide our choices in the moment. Presumably, when one goes to art school one learns about all the elements of what goes into making art, be it a painting, a sculpture, or photograph. And so students learn about light, color, balance, perspective, shape, concept, and tension, among other artistic values and components. All art contains these elements–and yet all art is different depending on one’s commitment to any one particular element. Emphasizing color over perspective produces a very different canvas from emphasizing shape over perspective. No two canvases are the same, and different schools produce widely differing views of the perceived world. Picasso is not Monet, and Rodin is not Miro. The same is true in psychoanalysis; that is, all the elements need to be taught, and every analysis contains some part of all the essentials: history, insight, interpretation, inquiry, transference, countertransference, dreams, associations, conflicts, responsibility, and authenticity, among others. And yet where we make our commitment–where we place our emphasis–produces a very different canvas or experience. This may be hard to determine in any given session, but over time our analytic values define our work and separate us one from the other. In thinking about the value of analytic authenticity, I am reminded of an old George Burns comment: The secret to success in life is being sincere, and once you can fake that you’ve got it made. It’s a good line, and it may even be generally true, but not in the analytic office. As in art school, we as analysts need to learn all the basic elements that inform our craft. But make no mistake, an analyst’s (and arguably any therapist’s) values regarding issues such as authenticity will define the true nature of the treatment canvas.
Selected References and Recommended Readings Aron, L. & Ragen, T. (1993), Abandoned workings: Ferenczi’s mutual analysis. In L. Harris & A. Harris (Eds.), The Legacy of Sandor Ferenczi (pp. 217–226). Hillsdale, NJ: The Analytic Press. Basescu, S. (1990a). Show and tell. In G. Stricker & M. Fisher (Eds.), Self-disclosure in the therapeutic relationship (pp. 47–59). New York: Springer. Basescu, S. (1990b). Tools of the trade: The use of the self in psychotherapy. Group, 14(3), 157–165. Blanco, P. J., Muro, J. H., & Stickley, V. K. (2014). Understanding the concept of genuineness in play therapy: Implications for the supervision and teaching of beginning play therapists. International Journal of Play Therapy, 23(1), 44–54.
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Ferenczi, S. (1933). Confusion of the tongues between the adults and the child–(The language of tenderness and of passion). International Journal of Psychoanalysis, 30(4), 225–230. Ferenczi, S., & Rank, O. (1925). The development of psychoanalysis. Nervous and Mental Disease Monograph Series, No. 40. Washington, DC: Nervous and Mental Disease Publishing Co. Fromm, E. (1955). The Sane society. New York: Rinehart & Co. Goldstein, G., & Golden, H. (Eds.), (2010). Sabert Basescu: Selected papers on human nature and psychoanalysis (Vol. 42). London: Routledge. Hirsch, I. (2011). On some contributions of the Interpersonal psychoanalytic tradition to 21st-century psychoanalysis. Contemporary Psychoanalysis, 47, 561–570. Hirsch, I. (2014). The Interpersonal tradition: The origins of psychoanalytic subjectivity. London: Routledge. Jung, E., Wiesjahn, M., Rief, W., & Lincoln, T. M. (2014). Perceived therapist genuineneness predicts therapeutic alliance in cognitive behavioural therapy for psychosis. British Journal of Clinical Psychology. doi:10.1111/bjc.12059 Knox, S., & Hill, C. E. (2003). Therapist self-disclosure: Research-based suggestions for practitioners. Journal of Clinical Psychology: In Session, 59, 529–539. Kolden, G. G., Klein, M. H., Wang, C. C., & Austin, S. B. (2011). Congruence/genuineness. Psychotherapy, 48(1), 65–71. Lambert, M. J. (1992). Psychotherapy outcome research: Implications for integrative and eclectic therapists. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94–129). New York: Basic Books. Levenson, E. A. (1987). The purloined self. Journal of the American Academy of Psychoanalysis, 15, 481–490. Miller, J. B., Jordan, J. V., Stiver, I. P., Walker, M., Surrey, J. L., & Eldridge, N. S. (2004). Therapists’ authenticity. In J. V. Jordan, L. M. Hartling, & M. Walker (Eds.), The complexity of connection: Writings from the Stone Center’s Jean Baker Miller Training Institute (pp. 64–89). New York: Guilford Press. Norcross, J. C., & Lambert, M. J. (2011). Evidence-based therapy relationships. Psychotherapy relationships that work (2nd ed., pp. 3–21). New York: Oxford University Press. Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103. Schnellbacher, J., & Leijssen, M. (2008). The significance of therapist genuineness from the client’s perspective. Journal of Humanistic Psychology, 49(2), 207–228. Singer, E. (1968). The reluctance to interpret. In E. F. Hammer (Ed.), The use of interpretation in treatment (pp. 364–371). New York: Grune & Stratton. Stern, D. B. (2003). Unformulated experience: From dissociation to imagination in psychoanalysis. London: Routledge. Thompson, M. G. (2006). Vicissitudes of authenticity in the psychoanalytic situation. Contemporary Psychoanalysis, 42(2), 139–176. Winnicott, D. W. (1955). Metapsychological and clinical aspects of regression within the psychoanalytical set-up. The International Journal of Psychoanalysis. 36, 16–26. Wolstein, B. (1983). The first person in interpersonal relations. Contemporary Psychoanalysis, 19(3), 522– 535. Wogan, M., & Norcross, J. C. (1985). Dimensions of therapeutic skills and techniques: Empirical identification, therapist correlates, and predictive utility. Psychotherapy: Theory, Research, Practice, Training, 22(1), 63–74.
