Erich Fromm: Clinical Mountain Guide

ABSTRACT

Each psychoanalytic theory influences the clinician’s focus. This paper examines the impact of Erich Fromm’s writing on the analyst’s attention to the material in sessions. Briefly, Fromm’s work highlights the importance of the analyst’s passion, courage, pursuit of truth, capacity to bear uncertainty and suffering, and dedication to helping people embrace their freedom and realize their full potential. Fromm has inspired generations of clinicians to become politically active citizens, maintain enlivening curiosity, and kindle the life force in themselves and those they treat. What role does theory play in the moment-by-moment behavior of the analyst in a session? I first address the general question of my view of the role of theory in clinical work. Then I turn to the more specific issue of Fromm’s influence.

KEYWORDS:

• Fromm
• guide
• curiosity
• passion
• life force

 The Role of Theory in Clinical Practice

I think in this process the personality of the analyst is very important,

namely whether he is good company and whether he is able to do what

a good mountain guide does, who doesn’t carry his client up the mountain,

but sometimes tells him: “This is a better road,” and sometimes even uses

his hand to give him a little push, but that is all he can do.

   “Factors leading to patient’s change in analytic treatment,” reprinted

     from The Art of Listening, New York, The Continuum Publishing

                                             Corporation, 1994a, pp. 96–162. In The Clinical Erich Fromm, Funk, 2009, p. 53

Like a good mountain guide, theory points the clinician in the direction of a promising perspective, but doesn’t tell us what to see, or what to feel about what we see. For me, each psychoanalytic theory I study serves at least three purposes. First, it heightens my attention to particular aspects of a session. It focuses me on them, rendering me ready to see and hear them, remember them, and, perhaps, respond aloud or silently. Secondly, theory helps consolidate my conviction about my work. I need to believe in it enough to pursue it with adequate confidence. More specifically, I need to believe not only that treatment often helps people lead richer lives, but that treatment with me could do so. Like the mountain guide, theory provides some guidance, lending credence to the belief that we are going in a s productive direction. Finally, at least for me, theory can be inspiring, sustaining the stamina long term treatment often requires. In what follows I spell out each of these three functions of theory.

As I see it, theory’s greatest impact is on the clinician’s focus. I have come to believe that our attention is our most impactful intervention. Clinicians face a daunting array of potential focuses every moment of every hour. William James’s conception of the mind as a theater of simultaneous possibilities (discussed in Izard, 1977, p. 134) seems to me to be an apt characterization of the myriad choices a session presents. There is no way to foreground them all. For example, we may ask ourselves whether we should focus on any particular sentence and highlight its similarity to something the patient said previously. Should we ask a question about that sentence? Might we think of it as defensive? Should we assume it reveals underlying, unconscious processes, and listen for evidence of what is being defended against? Whatever we focus on, or focus away from, expresses what we think is most significant, in treatment and, more generally, in life. As an example, the clinician who highlights the patient’s emotions is making an (often unspoken) statement about the importance of feelings. This unarticulated emphasis can be more subtly impactful than a verbalized interpretation because it often goes under the radar, so it is unlikely to be challenged. It can be the implicit but, nevertheless, most meaningful message of many sessions.

To take the issue of focus further, today’s clinicians might wonder whether or not to reveal their own emotional reaction to a patient’s comment, or they might determine to remember this sentence in subsequent sessions, or just let it pass, unnoted, waiting for something that sounds more “significant.” In my own many years of practice, I remember few times that a specific theoretical concept consciously determined my moment-by-moment focus of attention. It felt as though there was not enough time to wonder what Freud, or Fromm, or Winnicott would privilege, as sentence piled on sentence. More often I consciously called upon the general advice from my supervisors to “follow the red thread.” That is, I remembered their advice to wait until a theme emerged before overtly intervening.

But what guided my attention on less than conscious levels? Did years of clinical experience change how I focused? In order for theory to guide our movement it has to be bred in the bone, so to speak. For each clinician, the development of a therapeutic approach entails the absorption of various influences into a personally resonant signature style. Some may be guided more by their own experiences as patients, supervisees, students, readers, or in other relationships. Allegiances to spiritual, political, or philosophical values play a greater part than some clinicians would like to admit. Lingering beliefs in the possibility of therapeutic “neutrality” guide how some of us think about what we do clinically (Buechler, 2012, 2015, 2017, 2019), but not, necessarily, how we actually focus and respond. More about this in a subsequent section.

For example, a man comes into treatment and speaks about grieving the loss of his wife. The clinician asks how long ago his wife died. The patient may (perhaps correctly) read this question as expressive of the clinician’s assumption that grief is a process that should subside over time. Both professionals and nonprofessionals often make such assumptions about healthy mourning. The ordinary response of focusing on the time that has elapsed since the loss expresses (to both participants) an expectation of a relationship between time and grief. The analyst could be holding a belief that “healthy” people “move on” from grieving. The patient may “hear” this assumption on a less than conscious level and be affected by it without being aware of it enough to challenge it, or even consider other possibilities. To make matters even more complicated, I would suggest that not asking about the time elapsed since the loss can also have an impact. How we focus communicates a great deal about our beliefs and is, in a sense, our most frequent interpretation of what aspects of experience may be connected to each other, and, more generally of what is most relevant to the treatment. Theory can operate invisibly to guide the clinician’s attention toward some words uttered in the session, or some non-verbal behaviors, or emotional expressions, or their absence. To me, this is theory’s most significant role in treatment.

Secondly, I suggest that holding any theoretical position can help clinicians develop sufficient conviction to do their work. Despite its potential for potentiating factionalism, some grounding in theory is essential for the clinician. Rollo May put it succinctly when he said (1967, p. 155) “Concepts are the orientation by which perception occurs. Without some concepts presupposed the therapist would not see the patient who is there or anything about him.” A conceptual framework of some kind is necessary in order for the therapist to develop a personally resonant clinical voice. Like any process of identity formation, developing one’s therapeutic voice entails identifying with some of the values of predecessors, discovering where one differs, and, eventually, formulating a personal style of one’s own. Shortly after graduating from analytic training, I (1988) wrote a paper that likened the training process to a recapitulation of one’s adolescence. Both require a capacity to emerge from embeddedness in a group, having internalized its teachings which, ideally, should prepare us to develop our personal variation or stamp. For the analyst, theory is part of the tradition handed down.

Since a good deal of my previous writing has dealt with the analyst’s development of a personally resonant style (1993, 1997, 1999, 2004, 2008, 2012, 2017, 2019) I will not repeat it all here, except to state that honing that style is what can lend clinicians conviction about their work with patients. Like artists, therapists need to believe in their intuitive capacities. Without the luxury of time in which to consider every word, we need to trust our moment-by-moment responses.I have heard that the painter, Kandinsky, believed that each brush stroke should come from inner necessity. In other words, something inside him pulled him toward painting one particular stroke, rather than any other. Obeying this pull, Kandinsky could feel conviction. This analogy is not meant to endorse a return to blindly following the dictates of an internalized “correct” approach, in which practitioners forced patients into Procrustean beds, and pressured them to lop off any bits that didn’t conform. This resulted in some shameful, harmful treatments. I greatly value the changes in our field that affirm a respectful consideration of the multiplicity of human perspectives. But in order to inspire passionate commitment to psychoanalysis I believe we need something more than just this respect, something like the artist’s pull of inner necessity. Elsewhere (2004) I have described this pull as the clinician’s “sense of purpose.” Clinicians need to feel guided by convictions about how treatment matters. I see theories as helping us coalesce conviction. To extend my analogy to the artist’s pull, in fantasy If I could challenge Kandinsky, I might ask him how he lives with the knowledge that some, with a different perspective, might say his brush stroke would work better in blue. I imagine him staring in speechless wonder at someone so little acquainted with the creative process. “Don’t you understand, “my fantasy Kandinsky asks, “that I have spent many years learning my way around a canvas, honing basic skills to such a degree that when I feel the pull of inner necessity, I trust it, I believe in it, and I follow it with my whole heart?”

Besides guiding our inevitably selective focus and the development of a conceptual foundation for our signature style, a third function of theory is its capacity to provide emotional inspiration. Clinical endeavors are often spurred on by curiosity and hope. Theories suggest what we might be curious about, and what we might hope for. More generally, theories can help us access positive feelings as we are doing treatment. For example, by describing the arc of treatment, theories ready us to feel joy when we and our patients achieve milestones. Elsewhere (2008) I have explored the moments of joy that can motivate the work of both patient and analyst. Joy is a natural human response to the overcoming of any obstacle. We all cheer when children take their first steps or when anyone breaks free of debilitating inhibitions. By defining treatment’s milestones, theory legitimizes these celebrations. It also sometimes comforts us when the going gets rough, validating our struggles, accompanying us so that we don’t feel too lonely, letting us know that other clinicians have faced similar challenges. Elsewhere (2012) I have suggested that theoretical concepts can function like Winnicott’s transitional objects for the clinician, giving us something to “play” with when we need it. When a concept from theory matches a clinical moment, I know a therapist has survived a somewhat similar situation. For me, it is rather like my experience reading some poems. I feel comradeship. Of course, clinical theories address much more than suffering, but I think they have special value in inspiring us during painful sessions. For a beautiful expression of the effect of imagined fellow sufferers, I turn to Edgar, the character in Shakespeare’s (1997) King Lear, that disguises himself as a wretched, ragged beggar:

   When we our betters see bearing our woes

We scarcely think our miseries our foes.

Who alone suffers, suffers most I’th’mind,

Leaving free things and happy shows behind;

But then the mind much sufferance doth o’erskip,

When grief hath mates, and bearing fellowship.

        Act III, Scene 6, lines 100–105

More generally, clinicians need theories for inspiration, so we can muster enough humility, stamina, and sense of purpose to return, again and again, to “raid the inarticulate.” This phrase comes from T.S. Eliot’s poem, “East Coker,” in which he talks of

…..Trying to learn to use words, and every attempt

is a wholly new start, and a different kind of failure

because one has only learnt to get the better of words

for the thing one no longer has to say, or the way in which

one is no longer disposed to say it. And so each venture

is a new beginning, a raid on the inarticulate

with shabby equipment always deteriorating

in the general mess of imprecision of feeling,

undisciplined squads of emotion.

     (T. S. Eliot, “East Coker,” 1943, pp. 30–31)

We train people to conduct raids on the inarticulate. As Eliot writes, with astonishing precision, every attempt is a wholly new start, and a different kind of failure, and, as we all know, from these failures the analyst tries to fashion a new raid. The “shabby equipment” Eliot refers to, those undisciplined squads of emotion, are the tools of the analytic trade. Over and over the analyst gropes for the words to express what can never be captured in words. And, though our feelings guide us, though we give it everything we’ve got, we fall on our faces, only to dust ourselves off, reach inside, and gather the conviction, the stamina, the sheer determination to try again.

Put in another way, the clinician needs adequate inspiration to be motivated to take “long shots.” In clinical work, we are often operating against the odds. Why should my patient and I believe that what we do today will help, when it hasn’t helped before? And, yet we must be inspired to try. We each search, our whole careers, for what really helps anyone have a richer life. For me, the poet, Rilke best captured what makes our work so hard, and so worthwhile. In his Letters to a Young Poet (1934, pp. 23–24) Rilke says, “…at bottom, and just in the deepest and most important things, we are unutterably alone, and for one person to be able to advise or even help another, a lot must happen, a lot must go well, a whole constellation of things must come right in order once to succeed.”

Elsewhere (2008, 2012, 2017, 2019) I have explored how passionate dedication can be inspired in the clinician. Theories link us with a tradition of hard work in the service of helping people live richer lives. While they differ widely, they all affirm the indisputable value of this work.

So far I have suggested that all psychoanalytic theories serve at least three purposes: they direct our attention, provide a conceptual basis for the formation of conviction about our therapeutic style, and inspire the passionate dedication the work requires. In the following section I discuss how Erich Fromm’s thinking has fulfilled these functions for me.

Erich Fromm’s influence on my clinical work

Privileging experience in sessions over interpretation

Essentially, as I understand Fromm’s perspective, we help people by relating to them in a very direct way, so that they feel less isolated, and by avoiding intellectualization. As quoted by Rainer (Funk, 2009, p. 34): “…the task of analysis is that the patient experiences something and not that he thinks more” (italics in original). Fromm believed that we should not withhold what we see, out of concern that the patient isn’t ready to hear it, because that would not fully reach him. In Fromm’s words, when you think you see something, you have to “stick your neck out” (Quoted in Funk, 2009, p. 36) and say it. My own way to describe this (2004, 2008) has been that the analyst has to have the courage to voice inconvenient truths. Ideally, as a result of the experience of direct relating, the patient leaves the session with an exhilarated feeling of increased vitality. Training (including one’s personal analysis and supervision) should enable us to become radical truth tellers.

My version of Fromm’s idea is that it is primarily life experience that changes people, but, ideally, treatment can make more life experience (both within and outside treatment) possible. In other words, it is interpersonal exchanges, (including during treatment) rather than abstract interpretations, that are the most powerful agents of change. They help people actually live their lives differently.

Fromm (2000; “Dealing with the unconscious in psychotherapeutic practice,” International Forum of Psychoanalysis, Vol. 9, 3–4, October 2000. Reprinted in Funk, 2009) very clearly warned analysts against intellectualizing. My way to express this is that analysts too often waste time helping patients create a theory about themselves, at the expense of changing their lives. It is true that (theoretically) one can do both. But I think all too often ideas about the patient take precedence over actual experience in the session. Fully inhabiting this belief can have great impact on the clinician’s focus in sessions, as well as the content of interventions.

We can approach the same idea by looking at Fromm’s view of health. For Fromm health is a relative absence of dissociation. He generally preferred to use the term dissociation, rather than repression, for what is not conscious. In his paper, “Being centrally related to the patient” (quoted in Funk, 2009, p. 7), Fromm explains that the repressed refers to what was conscious and now is not. In contrast, the dissociated can refer to what was conscious and what was never conscious. Thus, it is a more inclusive term, which allowed Fromm’s version of the unconscious to include whatever a particular society filters out of members’ awareness. The concept of the “social filter” distinguishes Fromm’s thinking from other theories. In practice, since the analyst generally belongs to the same society as the patient, theoretically the same filters would blind clinicians and patients. What can we do about this limitation? Personally, this has led me to look for, and accept, a set of “clinical values” (Buechler, 2004) that I think supersede the values of any specific culture. I suggest that values such as hope, courage, integrity, emotional balance, and the ability to bear loss are relevant to treatment regardless of era and geography. I recognize that holding this belief does not entirely free me from the limitations of the social filter I share with others in my culture. It is my effort to see beyond them, but it is fraught with its own pitfalls (see Buechler, 2019, chapter 5, for a discussion of this issue).

Promising no more than we can deliver

Fromm (2000/2009) was quite explicit about the damages of implicitly or explicitly making promises in treatment that we may not be able to fulfill. Its results can include a permanent state of anxiety in the clinician. In my 2012 book, Still Practicing, I explored the demoralization that can accumulate over time, when the analyst over-promises. I believe that the damage can include a painfully hollow feeling (and, perhaps, a projection of one’s own resulting sense of impotence) onto the field itself, rendering the analyst despairing about the viability of psychoanalysis. For the individual analyst, the long-term effect can be a form of burnout, which is not unlike depression. For the field as a whole, the effect can be corrosive.

Personally, I like the way (2000/2009) Fromm avoided promising more than he knew he could deliver. He believed that analysts can’t guarantee results, but we can offer “central relatedness:” Here is how he (p. 18) described what is possible: “Then I do not think about myself, then my Ego does not stand in my way. But something entirely different happens. There is what I call a central relatedness between me and him. He is not a thing over there which I look at, but he confronts me fully and I confront him fully, and there in fact is not way of escape.”

Expanding this idea, I (1999, 2012, 2017) wrote about the analyst’s “non-narcissistic investments” in the patient’s well-being. Here is how I described that investment in 2012 (p. 17):

 …..we should be responsive to the needs and feelings of the patient,

but we should not have a personal stake in the patient’s life-style choices.

We should not be narcissistically invested, that is, worried about how the

treatment makes us look to ourselves. We shouldn’t need a “success” with

this patient to prove ourselves as clinicians. So, from a narcissistic point of

view, we are neutral and not dependent on any particular outcome. But,

from a human point of view, the outcome cannot be a matter of

indifference to us. Passionate engagement in treatment is a genuine

investment in life itself.

In agreement with Fromm, I tried to define what I think we can promise, to differentiate it from what we cannot. To me, being an analyst means committing to a lifetime of working on our own motivations and investments in the work we do. While we can’t ensure any specific outcome, we can determine to dedicate ourselves to a genuine encounter, and we can pledge to examine our part in it. We can endeavor to facilitate the patient’s creation of a rewarding life. We can’t know whether a particular person should get married or move to Westchester. We shouldn’t promise to have answers to these questions. But we can, and, I believe, we should promise to engage with the patient in an honest and passionate process, that has at its heart caring about the quality of the patient’s life experience.

Directly facing suffering

Many personal and professional experiences taught me that suffering is inevitable in life, and must be faced directly, rather than defensively avoided. Fromm’s writing, and his influence on my training analyst, supervisors, and teachers, reinforced that lesson. In Fromm’s (in Funk, 2009, p. 51) own words, we “ … help the patient be unhappy … ” Fromm declares (same page) suffering “ … at least a very real feeling, and is a part of life.”

Fromm’s teachings readied me to be open to the writings of the poet Rainer Marie Rilke on the subject of suffering: “What, finally, would be more useless to me than a consoled life?” He advises us, “…to elevate suffering to the level of one’s own perspective and to transform it into an aid for one’s way of seeing” (in Baer, 2005, pp. 112–113).

My reading of Fromm and Rilke led me to consider how analysts’ attitudes about suffering affect our behavior in treatment and, more specifically, our work with defenses. In a paper entitled “No pain no gain?: Suffering and the analysis of defense” (2010/2017) I differentiated three stances:

1. The stance closest to a medical model treats emotional pain as a symptom and its reduction or elimination as a goal. Therefore, any method that might delimit suffering, such as medication, should be employed.

2. A second view, that I see as aligned with a classical analytic approach, considers suffering as a human inevitability. From this position, an important goal of psychological treatment is to facilitate efforts to become better able to accept suffering as a part of the human condition, endure it courageously, and with strength and dignity. For example, in Breuer and Freud’s (1895/1956, p. 305) famous statement about the goals of analysis: “…you will be able to convince yourself that much will be gained if we succeed in transforming your hysterical misery into common unhappiness. With a mental life that has been restored to health you will be better armed against that unhappiness. “

3. For centuries, many philosophers, religious leaders, and other scholars have seen suffering as the royal road toward some form of enlightenment, wisdom, or personal identity. For these authors suffering is the path toward redemption and self-knowledge. Applying this to treatment suggests that it should further patients’ ability to learn from suffering.

While all of these attitudes have currency, in this paper I suggested that clinicians differ some in whether we mainly focus on suffering as a symptom, an inevitable burden, or a window of opportunity. Each of these positions, which may not be conscious in the analyst, have significant impact on the analysis of defense. Briefly, my conclusion (2010/2017, p. 274) was that:

…those who (because of their characters and personal and professional

experiences) believe that ignorance can be bliss are the analysts likely to

be friendliest toward defense, reluctant to interpret it early, regardless of

their theoretical orientation (although this attitude about suffering may

incline them toward adopting some orientations more than others). I

have also discussed the likelihood that, in contrast, analysts who believe

that only the truth can set us free will interpret defense early.

They will see the defense as, itself, a central problem, taking up energy

that could be better spent and adding dissociative disconnections and

hysterical symptoms to the patient’s miseries. But for those who see

suffering as the royal road to enlightenment, humanistic wisdom, or

personal identity, defenses are neither friend nor foe. They are simply

not the point. Unlike their colleagues in the first two groups, these

analysts are neither loath to interpret defense nor eager. Their focus is

elsewhere. They are looking for hurt, not for what blocks awareness of

pain, but for the humanizing function of the pain itself. (Italics added)

Questioning adaptation as a therapeutic goal

I trained (at the William Alanson White Institute from 1979–1983) primarily with an analyst, supervisors, and teachers who had worked with H.S Sullivan and Erich Fromm. In my experience one of the ways that the legacies of Sullivan and Fromm differed was in the analyst’s attitudes about adaptation to society’s dictates. Even in this area there was overlap, but, from my point of view, those who identified themselves with Fromm’s work were more emphatic in their rejection of the idea of health as adaptation.

Briefly, in much of his work, Erich Fromm (1941, 1950, 1955, 1968) advised human beings, in general, to challenge society’s dictates. Fromm believed we should be skeptical about society’s influence. This contrasted some with the goals of Sullivan (1953, 1956) who quite frequently struggled to help his psychotic patients develop socially sanctioned styles of dealing with “problems in living.” This was not a uniform message, in that, for example, regarding the issue of homosexuality, Sullivan’s attitude was hard to characterize. As Wake (2011) delineated, sometimes Sullivan championed questioning society’s dictates, but at other times he seemed willing to support and even implement them.

Fromm more consistently persisted in his position that health should not be equated with adaptation to society. In Psychoanalysis and Religion (1950, pp. 73–74) Fromm says:

   We find that according to one conception adjustment is the aim of analytic

cure. By adjustment is meant a person’s ability to act like the majority of

people in his culture. (p. 73)

Fromm goes on (p. 74) to describe a second view in which:

 …the aim of therapy is not primarily adjustment but optimal

development of a person’s potentialities and the realization of his

individuality.

Fromm leaves no doubt that the second attitude is his belief about healthy living and about the clinician’s task. In my understanding, he based his position on the conviction that society can be unhealthy, so adjusting well to it would not constitute health. This point of view assumes that there are universal norms for psychologically healthy living, against which a specific society’s requirements can be compared. In Fromm’s (1950, p. 74) words:

   Here the psychoanalyst is not an “adjustment counselor” but, to use Plato’s

expression, the “physician of the soul.” This view is based on the premise

that there are immutable laws inherent in human nature and human

functioning which operate in any given culture.

In subsequent passages, Fromm (p. 76) suggests that these universal “laws” include recognizing the truth, becoming independent and free, being ends in themselves, (rather than being the means by which others’ achieve their ends), relating lovingly, distinguishing good from evil, and listening to the voices of their own consciences. For Fromm, each human being should strive toward the fulfillment of these goals, and clinicians should help their patients in this endeavor. Commentators (Burston, 1991; Funk, 2019) have suggested that this viewpoint was rooted in his studies of societies that supported the rise of Hitler, as well as his more general religious, philosophical, historical, and other research.

In my own work, I have spelled out (2019) some of the implications of this way of thinking on the clinician’s attitudes toward the fundamental difficulties that face human beings, such as bearing aloneness, mourning, aging, suffering, uncertainty, humiliation, hardship, and helplessness. Cultures attach somewhat different meanings to these issues, but, as I see it, they are recurrent themes. I believe that all clinicians would do well to reflect on our own cultural and individual experiences with these human challenges.

Embracing contradiction and paradox

It has been invaluable to me to grasp that the contradictory and paradoxical can be true. I have often taken heart from Fromm’s statement:

   To have faith means to dare, to think the unthinkable, yet to act within

the limits of the realistically possible; it is the paradox of hope to expect

the Messiah every day, yet not to lose heart when he has not come at the

appointed hour. (Fromm, 1973, p. 485)

For me this suggests that contradictions do not, necessarily, mean that we should choose one side to be true and the other false. The Messiah has not come at the appointed hour, but that doesn’t mean we should alter our expectations. In Rainer Funk’s elaboration of Fromm’s thinking (Funk, 2019, p. 139) the inability to hold contradictory assertions characterizes the problematic “ego orientation.” Funk offers the example of the person who cannot accept that “ … their partner, their parents, their children, their work can be satisfying and stressful, a blessing and a curse” (italics in original). According to my dictionary (New College Edition, American Heritage Dictionary) the paradoxical is a broader concept, in that it includes contradictions of received wisdom. I think this connects the embrace of paradox with Fromm’s inquisitive stance about adaptation to society’s expectations.

In my own work, I have examined a number of contradictions, paradoxes, and counterintuitive beliefs that I hold to be both clinically relevant and true. Here are some examples:

1. Human beings express ourselves in characteristic patterns, nothing human is alien to us, we are more alike than different, and yet each of us is a unique individual, with a personal history that informs our experience.

2. The analyst’s values have an inescapable (and invaluable) impact on the treatment, and yet, patients need a neutral space in which to explore their own feelings and choices. I discuss this thorny issue separately in a subsequent section.

3. There is no such thing as an objective reality, unaffected by the observer (which clearly includes analysts) and yet, sometimes treatment is a passionate search for the truth.

4. Ideally, treatment hours have a timeless quality, with many of the usual constraints suspended, exploring the endless, dateless flow of unconscious processes, and yet, treatment exists in a specific culture, place, and finite time.

5. Treatment participants are intimate strangers who know and don’t know each other, who are completely equal as human beings, yet with different roles, expectations, and entitlements.

6. Unlike any other significant relationship, treatment’s aim is its own obsolescence. While children outgrow some of their needs for a parent, the expectation is that the relationship will survive. But treatment is predicated on the idea that part of its goal is to become unnecessary.

7. Presumably the analyst is emotionally engaged with the patient but then, at the sound of the buzzer that signals the arrival of the next patient, our attention switches, and we are expected to be fully involved in the new session without any lingering remnants of the previous hour.

8. The treatment relationship depends, for its very life, on what is left out of it. It is a relationship partially defined by what will never happen. Of course, sexual contact is completely forbidden. We don’t cuddle or dance together. Beyond that, there are many other nonphysical prohibitions. For example, the analyst is proscribed from asking knowledgeable patients for stock market tips, among other professional courtesies.

9. While patients often liken psychological treatment to medical services, analysts cannot promise “cure” (or even define it, in many cases). Many patients come into treatment wanting immediate help with specific challenges they are facing in their lives. Analysts may, or may not, be explicit about the time treatment generally takes, and any differences between what patients want and what we can reliably provide. Even so, we need conviction that what we do will, eventually, help the patient live a richer life, and we need to inspire that faith in the patient, but much of this simply can’t be explained in early sessions. I have sometimes referred to this (somewhat provocatively) as the “seduction” that is necessary at the start of the work.

10. We are entrepreneurs, paid for our services, yet what we offer is predicated on an emotionally informed, caring relationship. This may not be truly contradictory, but it can sometimes seem as though it is.

11. We are “trained” by experts, who often don’t agree on the methods or even the goals of analysis. Furthermore, while we have been taught treatment paradigms, we are expected to operate spontaneously, in the moment.

12. As analysts we need both a grounding, centering conviction in our work and the humility to embrace its (and our own) limitations. We need faith that the chaotic experience of sessions, and our own confusions (about our role, who the patient is, what the goals are, which theory can best guide us, and how we can be adequately equipped) will, eventually, resolve, although, sometimes for very long periods of time, there is no evidence that anything will ever change.

13. We generally communicate belief in the patient’s subjective experience, but, through the analysis of defense, we are also searching for what is “really true” and defended against by the patient.

14. More generally, clinicians often need to hold seemingly counterintuitive positions about our own work lives. We need to believe that hard work may refresh us, embracing a patient’s despair may lift it, (since, at least, the patient may feel less alone) and a patient’s depression that has lasted many years, that feels unendurable and unyielding, may be overcome.

The thorny “evaluative question”

For me, the most complicated and consequential part of Fromm’s clinical legacy is his “prophetic” voice. In a trenchant article, Maccoby (who was in treatment with Fromm) wrote (in Cortina & Maccoby, 1996, pp. 61–93) that Fromm’s tendency to preach could sometimes interfere with his role as an analyst. I have spent much of my treating and writing career puzzling over the question of how one’s passionate beliefs can be integrated into a sufficiently open therapeutic stance. One of the most difficult papers I ever wrote was entitled “Searching for a passionate neutrality” (1999). In that paper (and ever since) I have wrestled with what I could and could not accept about analytic neutrality. Briefly Anna Freud (1936) (and many analysts since then) suggested that the neutral analyst should maintain an even focus on material coming from the patient’s id, ego, and superego. Furthermore, countertransference passions should be held in check, analysts should not impose their values, should refrain from “helpfulness,” and should follow the unfolding material, with an unhurried posture.

In the 1999 paper I summed up where I stood:

    A neutrality I could embrace would have to leave me free to encourage the

patient’s active efforts to fight depression. It would have to allow me to

present enough of a new relational challenge to foster hope. It would have to

include a valuing of urgency about not wasting time. And it would have to

leave me free to describe the patient’s impact on me, so that I can help him

understand the differences between his intentions and his effect.” (pp. 225–226)

This position clearly owes a great deal to Fromm. Fromm pleaded with us to choose life, to embrace and not escape our freedom, to awaken to fervent living. He begged us to care about the society we live in, and not just our own small circle. He awakened us to the dangers of becoming society’s automatons. He pushed us to question materialistic, acquisitive values. He spoke in a language that reached out to millions of college students (including me). He touched our hearts, by appealing to our humanistic inclinations. He made demands. He saw who we could become, and wanted us to strive for it, for ourselves, for society, and for life. His legacy is precious to me. Can we embrace that legacy, and still remain profoundly open?

In 2017, in an introduction to a reprint of the 1999 paper, I took up its issues again. In brief, my lifelong goal has been to retain Fromm’s passionate convictions without sacrificing patients’ freedom to explore all their feelings fully. Basically, the aspect of neutrality we must retain is the openness to hearing everything our patients tell us, verbally and non-verbally, consciously and unconsciously. But I don’t believe any analyst operates without some notion of health, and these notions inevitably affect our method, as well as our aims. For example, we may or may not be consciously aware of our own assumptions about healthy expressions of anger, fear, sorrow, and so many other feelings. But our assumptions will draw us to focus, perhaps question, remember, and perhaps interpret, some parts of the material in a session and not others. As I suggested at the beginning of this chapter, we could not possibly register everything, so, without always consciously knowing why, our attention, itself, selects some verbal and non-verbal messages over others. What we select is, I suggest, in part, a product of how we understand healthy functioning. Elsewhere (2004) I delineated a set of “clinical values,” that I believe generally inform our work. Let me be clear. I believe our values, honed by our personal life experience, professional experience, and cultural experience, inevitably affect our understanding of treatment’s goals and methods. At the same time, we should be aware that we owe our patients an open reception, a value free exploration of who they are, and who they want to become. Sigmund Freud’s (1912) evenly suspended attention, and Anna Freud’s (1936) equidistance between id, ego, and superego, are crucial, and, in my judgment, unachievable. This contradiction makes our work so very difficult. Perhaps we can think of it as the ultimate example of the contradictory-yet-true. Neutrality is as vital to analysis as is a passionate commitment to “clinical values” about what constitutes a healthy emotional life. Let me be clear. My position goes beyond recognizing that our values inevitably affect our behavior in sessions. I believe that they should have an impact. The conundrum is that we have a duty to promote health and a duty to provide a neutral space. The challenge each clinician faces is carving out a personally resonant integration of these goals.

Might we differ with each other on how we each understand health? Sure. I happen to believe strongly in Fromm’s concept of productive living. Perhaps some of us have other conceptions of health. Regardless, unless we raise our own consciousness of the conceptions of health each of us has taken in, from our experiences in the world, our slants will operate outside our awareness, but, I believe, they will still affect our understanding of treatment’s goals, and our focus, selective attention (Sullivan, 1956) and perceptions in a session, as I suggested earlier. Outside our awareness, they will incline our hearing, distribute our vision, shade our tone, influence our memory, tense our muscles, and impassion us more at some moments than others. I believe that since our perceptions and interactions with the patient are inevitably colored by our conceptions of health, we should examine, discuss, and contrast these conceptions.

In a beautiful essay, in Cortina and Maccoby’s 1996 book, A Prophetic Analyst: Erich Fromm’s Contributions to Psychoanalysis, Marianne Horney Eckardt (“Erich Fromm’s humanistic ethics and the role of the prophet,” pp. 151–165) declares, “We are children of our Western cultural tradition. Our cultural values as well as our personal values are active ingredients in our way of conducting therapy, in what we respond to with pleasure or with concern. We do want to make our patients into beings who are more capable of loving, of being creative and less destructive. Let us affirm the fact that those are our own precious values that guide our enterprises” (Eckardt, 1996, p. 164).

I would argue that now more than ever, as clinicians and as human beings, we need Fromm’s conception of a humane society, and healthy, productive functioning. I hope we can examine how humanistic values can be integrated with an open, freeing, non-coercive, analytic method. I am aware that this will entail grappling with weighty contradictions. But if, as a society, we don’t find a way to integrate our values about health into our commerce, our philanthropy, our education, our psychoanalysis, and our daily lives, it could literally, cost our lives, and the lives of our children and grandchildren.

Conclusions: Inspiring psychoanalytic mountain guides

How might we describe the basic equipment of a psychoanalytic mountain guide? On my list, the first quality would be empathic attunement. My thinking about the role of empathy in treatment has evolved a great deal over time. I think it has circled closer to Fromm’s. I love what Harold Davis (2009, p. 87) wrote about Fromm: “His directness was a means of being in touch with a person without physically touching; the essence of empathy.”

Fromm stands for a passionate promotion of passion in treatment, which has always directly affected my writing and practice. His privileging of the power of human feeling very much appeals to me. His thinking about hope, his open promotion of biophilia, his distaste for cliché, canned interpretations, and sentiment, his compassionate humanism, his willingness to take positions, and stand up for what he believed in, and his championing of freedom, have moved me all my adult life.

From my perspective, we need Fromm now more than ever. My country is in an especially precarious moment in our history. Forces of fascism, bigotry, misogyny, and profound cynicism threaten to overpower us. I imagine Fromm would understand our potentially paralyzing sorrow but encourage us toward an active stance.

The poet John Keats (1817, quoted in Seiden, 2016, p. 118) coined the phrase “negative capability” to describe the capacity to remain in uncertainties, mysteries, and doubts, without any irritable reaching after fact and reason. This idea has helped me deal with the conundrum of the evaluative question (see previous section). As I suggested (above) I take it to be in Fromm’s spirit, and in accord with his view of paradox, that we hold both neutrality and passionate promotion of health as treatment essentials. The best I have been able to do is to see them as points on the opposite ends of a continuum, or a kind of mental see-saw. When I veer toward the “passionate” end, I tend to remember the value of neutrality. When I try too hard to occupy neutral territory, I find myself wondering what might be blocking my convictions. For me, this “see saw” operates similarly to the alternations between an other-directed and an inner-directed focus. That is, for a while I might center on perceptions of the patient’s feelings, and then find myself moving closer to my own inner experience. Or, momentarily focused on my inner experience I might then incline toward understanding the patient’s. Let me emphasize that this “back and forth” movement is not a consciously designed, deliberate “technique,” but, rather, a tendency that I can only recognize in retrospect. Clinicians naturally flicker. Our attention wanders from the present to the past, from theory to clinical moment, from dream to reality, from other to self, from unwavering principles to open ended curiosities. I think we function best when we are light on our feet.

Erich Fromm challenged us to practice passionately, live courageously, cherish truth, recognize expressions of the life force, face and tolerate insecurity, relate from deep within our centers, promote active hope, embrace life’s paradoxes, privilege being over having, dream about better lives for ourselves and our patients, stop escaping freedom, become less alienated from our own hidden desires, “other” others less, squarely face life’s inevitable suffering, become politically involved citizens, actualize our potential, stay curious, choose life. His inspiration profoundly affects my own strivings, professionally and personally, every day of my life.

For Fromm, we can’t truly love another person without loving all of humanity. As he put it (1956) in The Art of Loving, “If I truly love one person, I love all persons, I love the world, I love life. If I can say to somebody else, ‘I love you,’ I must be able to say ‘I love in you everybody, I love through you the world, I love in you also myself’” (p. 42). I believe that the well-equipped clinical mountain guide must be capable of love, in this sense.

Fromm argued passionately for psychoanalysts’ active involvement in politics. In “In the Name of Life: A Portrait Through Dialogue” (In “For the Love of Life,” Free Press, 1986, pp. 88–117) he pleads (p. 116): “…if we love our fellow humans, we cannot limit our insight and our love only to others as individuals. That will inevitably lead to mistakes. We have to be political people, I would even say passionately involved political people, each of us in the way that best suits our own temperaments, our working lives, and our own capabilities.” I think each of us must find our own way to rise to Fromm’s challenge.

Fromm’s influence played a major role in the formulation of my first book, Clinical Values (2004). The last chapter of the book addresses the clinical impact of holding various theories. For example, I explore how studying Sullivan or Fromm affects the analyst’s emotional equipment for doing treatment. I suggested (p. 169) that “ … Fromm can whip up our anger at wasted potential. He gives us a strong sense of purpose, hope, courage, and integrity. We feel we are fighting the good fight, on the side of the angels.”

I have always been grateful to my training for imparting an ideal of clinical inquiry (a legacy from H.S. Sullivan) and the passionate zeal of Fromm. I think of them as my Apollonian and Dionysian gods. Apollo invites me to freely survey all the territory before me. Dionysus, my mountain guide, points toward a promising perspective.

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Sandra Buechler

Sandra Buechler, Ph.D., is a Training and Supervising Analyst at the William Alanson White Institute. She is the author of Clinical Values: Emotions that Guide Psychoanalytic Treatment (Analytic Press, 2004), Making a Difference in Patients’ Lives (Routledge, 2008), which won the Gradiva award, Still Practicing: The Heartaches and Joys of a Clinical Career (Routledge, 2012), Understanding and Treating Patients in Clinical Psychoanalysis: Lessons from Literature (Routledge, 2015), Psychoanalytic Reflections: Training and Practice (IPBooks, 2017), Psychoanalytic Approaches to Problems in Living (Routledge, 2019), and Poetic Dialogues (IPBooks, 2021).