On Knowing and not Knowing: Theoretical and Relational Transformations During 50 Years of Practice

Abstract

Until at least 1990, the American Psychoanalytic Association advised dynamic therapists to present themselves as neutral, silent, emotionally distant, personally opaque and ‘seemingly unresponsive’. Therapists were encouraged to think of themselves as powerful authorities, trained to objectively analyze unconscious processes. The therapeutic relationship was carefully designed to foster regression, amplify transference and discourage spontaneous interaction. Relational theorists drastically revised the traditional, positivist guidelines. They argued that analytic treatment cannot reveal objective truth, that therapeutic narratives are co-constructed in a reciprocal, bi-directional, dialogic process, that the boundaries between patients and therapists should be flexible and permeable and that therapists should be authentic, emotionally engaged and selectively self-disclosing. The revisions are a 180° about face from what I originally learned. This paper describes my professional development over a 50-year period. Having originally learned to practice from a drive-ego-developmental perspective, I am now increasingly influenced by relational theories. The paper includes a theoretical discussion, two illustrative case studies and some reflections on the concept of neutrality. As my goal is to encourage other therapists to reflect on and discuss aspects of practice that puzzle them, and as I think confusion can, if attended to, generate professional development, the paper highlights some of my own conflicts and uncertainties.

Keywords:

• authoritarian and egalitarian approaches to treatment
• neutrality
• transference/countertransference
• not-knowing/knowing
• mutual discovery