The Risks of Therapist Passivity and the Potentials of Constructivist Influence

Abstract

Francesca Colzani’s rich report of her sensitive work with Elisa highlights the therapist’s struggle with the issue of the exercise of power and authority bearing on the patient’s choices. It is suggested that sometimes the analyst poses her dilemma in dichotomous terms, choosing, in effect, between coercion and passivity. Also, it is argued that moral choices can be obscured by a turn to medicalization, diagnosis and treatment, of the patient’s “condition.” An alternative is proposed in which the analyst may offer constructive suggestions imbued with her subjectivity—her experience of conflict and uncertainty—leaving Elisa room for the exercise of her own responsible agency. In finding her own voice, the analyst may awaken selves or aspects of self of the patient that might otherwise remain dormant, potentially to her detriment. An example of an interpretation of projective identification, with self-disclosure on the analyst’s part, is proposed that might encourage collaborative reflection on a seemingly dissociative dimension of Elisa’s way of being and relating.

Notes

¹ Negative capability: “A theory of John Keats, who suggested in one of his famous letters that a great thinker is ‘capable of being in uncertainties, Mysteries, doubts, without any irritable reaching after fact and reason.’ A poet, then, has the power to bury self-consciousness, dwell in a state of openness to all experience, and identify with the object contemplated” (Poetry Foundation, n.d.).

² I know this might be a manner of speaking, and in her presentation Francesca never came across as one who is prone to getting carried away with discoveries of absolute truths about Elisa in general, or about her state at a certain time.

³ I realize we are confronted with a whole different kettle of fish when the analyst does not especially like one or another performance or production that the patient presents, perhaps an eventuality meriting discussion within the panel and with the audience. For a brief comment by me on this issue, see Hoffman (2009b, p. 634n).

⁴ I’ve written about the conflation in psychoanalysis of any kind of influence with that of hypnotic suggestion, a conflation associated with the allegedly mesmerizing transference (see Macalpine, as cited in Hoffman, 2009b, p. 618).

⁵ It behooves us, moreover, always to be mindful of the way in which medicalization of human behavior and emotional life is notorious for its potential to serve as a disguised form of social control (Foucault, 1965; Greenberg, 2013; Wakefield & Horwitz, 2007, 2012).

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Notes on contributors

Irwin Z. Hoffman

Irwin Z. Hoffman, Ph.D., is Faculty and Supervising Analyst at the Chicago Center for Psychoanalysis and Adjunct Clinical Professor at the New York University Post-Graduate Program in Psychoanalysis and Psychotherapy. He is the author of a series of publications developing his “dialectical-constructivist” view, including his book Ritual and Spontaneity in the Psychoanalytic Process (1998) and a series of recent papers highlighting the responsibility of analysts and patients as moral agents in the analytic relationship and in the world.