Beyond Freud

A dose of common sense.

The "Listening Cure": The Past Influences the Present

The central importance of the therapist's attuned listening to the patient

 

In the June 9/16, 2014, issue of The New Yorker, two letter writers argue, in a section called, "Fear and Remembering," that many modern neuro-cognitive concepts and therapeutic techniques are virtually identical to concepts and treatment techniques originated by Sigmund Freud and elaborated by psychoanalysts such as Hans Loewald and many other analysts and psychodynamic therapists. 

In fact, and more importantly, there are contemporary scientific studies validating many basic psychodynamic concepts and treatment approaches. One such concept is "transference." 

Transference is a universal psychological phenomenon in which a person's relation to another person has elements which are similar to and/or are based on his or her earlier attachments, especially to parents, siblings, and significant others. In a psychodynamic treatment, particularly the more intense the treatment, a relationship between patient and therapist/analyst is fostered in which intense feelings are accentuated. As in any other relationship the patient sees the analyst/therapist not only objectively but imputes qualities to the therapist/analyst which are based on qualities of other important figures in his or her current and/or earlier life. A therapist thus can utilize the patient's experience of the therapist to understand the nature and difficulties of the patient's relationships in his/her current life and their connections to the patient's earlier life. 

 The phenomenon of transference has been scientifically demonstrated to exist and its utilization to be an important therapeutic ingredient in many psychotherapeutic interactions. 

Another basic psychodynamic construct is that of the "therapeutic alliance." This concept refers to the nature of the relationship between therapist and patient. It has been amply demonstrated that the nature of the relationship between a clinician and a patient is one of, if not the most important ingredient in psychotherapy, regardless of the therapist's theoretical orientation. 

 Yet in so many quarters psychodynamic ideas are considered "old fashioned" and fantastically implausible in contrast to cognitive techniques, such as CBT, which are considered modern and scientific. 

Why is that?

 There are many complex reasons for this conundrum. Here I will cite only one reason and in future communications will discuss others. 

 Many people consider a psychoanalyst or a psychodynamic therapist to be a "mind reader" who will penetrate a person's unconscious mind against the patient's will. This, obviously, is a scary idea that, of course, would steer people away from a psychodynamic therapist. In fact, however, psychoanalysts and dynamic psychotherapists do no such thing. 

 They do not read minds nor do they automatically translate a patient's communications, verbalizations, including dream images or play activities in a child, in a preconceived symbolic manner. Interestingly, this kind of "shooting from the hip" technique used to be called "wild analysis" and found to be very counter-productive. 

Instead a psychodynamic therapist listens to a patient's current concern, develops a strong therapeutic relationship, and jointly with the patient tries to understand the nature of the patient's symptoms and problems. This understanding may be facilitated by examining together the patient's ideas about the therapist (the transference). 

It is crucial to appreciate that a therapist's attuned listening to the patient is the most important tool a therapist can have. 

 Pacella Parent Child Center

The New York Psychoanalytic Society and Institute

West End Day School

 

Leon Hoffman, M.D. is the Co-director of the Pacella Parent Child Center, New York Psychoanalytic Society and Institute. He is a member of the American Psychoanalytic Association.

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