It is All Personal: Further Thoughts on Therapeutic Action: Commentary on Paper by Noelle Burton

Abstract

This paper concurs with Noelle Burton's view that the actual transactions that occur between analyst and patient engender change within the psychic structure of both parties. But how does the “outside” get inside, changing the mind and even the communication patterns in the brain? This paper describes how this may occur—as Burton's work demonstrates—through the elaboration of experiences of personal agency within the mind in the context of malleable relational experiences. In addition, the paper raises the question of whether a more comprehensive understanding of this process also renders distinctions often made in analytic discussion between “personal” and “analytic” expression no longer meaningful or useful. In this context, the question of “self-disclosure” must be also reformulated as part of a fully professional, disciplined, if sometimes unconscious, analytic responsiveness, and not some split-off eruption that may or may not have coincidental positive therapeutic effect.

Acknowledgments

Thanks to Mia Medina, Psy.D., and Miki Rahmani, M.A., for their careful reading and substantive suggestions on drafts of this discussion.

Notes

¹In this framework, psychoanalytic therapy is certainly a cognitive-behavioral therapy, and perhaps much more (Shedler, 2010).

²I use the term analyst and therapist, and analytic and therapeutic, interchangeably as I believe that the issues raised apply to any psychotherapeutic work that aims to make significant change in the inner workings of the psyche. Indeed, whether there is even a viable distinction to be made between psychoanalysis and psychoanalytic therapy (J. Slavin, 1992) is a question that is beyond the scope of this discussion.

³ Ferro (1993) seemed to be suggesting a similar view when he stated that “the analyst's mind is the first locus of any possible change” (p. 928). However, it is not clear if his view of the process, as may be true with others whose thinking is influenced by the work of Bion, predicates this change as having emerged through the real, actual, albeit sometimes subtle and complex, transactions that occur between patient and analyst in which the patient, like the infant with the mother, tests the possibility of agency in a new relationship; or whether the change within the analyst's reverie is engendered essentially from within his or her own internal, unconscious processes. The differences in meaning in these positions may seem subtle, but I believe they are critical to understanding the true impact of reality, of real, actual interactions on psychic structure.

⁴I also concur with Burton's suggestion that analysts who embrace and are trained from within the frame of reference of expecting and knowing they will be drawn into a complex emotional whirlpool that implicates them personally may be less likely to be seized by the temptation to act unprofessionally.

⁵Burton is right about the deleterious and iatrogenic effects on patients working with removed, impenetrable, studied, and unavailable analysts and therapists. I suggested in an earlier paper (Slavin, 1994)that some therapists who may be less experienced (and with little relation to classical psychoanalytic injunctions) may adopt a caricature of a “classical” stance as a consequence of the struggle to avoid vulnerability to the impact of the transference.