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The Grace of Accuracy

Like poetry, psychotherapy has its own rules for punctuation


Just weeks before his death in 1977, the poet Robert Lowell published Day by Day, a collection of poems that marked a significant shift toward a minimalist and confessional style—a style Lowell would be remembered for. His newer streamlined verses were a contrast to the rhythmic, longer sonnets published previously. We see Lowell reflecting on his own rhetoric in "Epilogue." The poem is provocative—raising questions about truth verses imagination in art, as well as Lowell's apparent working out of his new rhetorical style. One senses a tension that he explores between accuracy and memory, and Lowell comes across as ambivalent about whether he can tell the truth of his experience with words (as accurately as Vermeer can paint). He parodies his earlier style ("lurid, rapid, garish, grouped") and prays for "the grace of accuracy" in depicting his experience:

Those blessed structures, plot and rhyme—

why are they no help to me now

I want to make

something imagined, not recalled?

I hear the noise of my own voice:

The painter’s vision is not a lens,

it trembles to caress the light.

But sometimes everything I write

with the threadbare art of my eye

seems a snapshot,

lurid, rapid, garish, grouped,

heightened from life,

yet paralyzed by fact.

All’s misalliance.

Yet why not say what happened?

Pray for the grace of accuracy

Vermeer gave to the sun’s illumination

stealing like the tide across a map

to his girl solid with yearning.

We are poor passing facts,

warned by that to give

each figure in the photograph

his living name.

Psychotherapy is officially a healthcare service but quite unofficially an art. Those of us that practice psychotherapy cannot decide whether we are mental health practitioners, applied humanists, or artists. What is clear is that what we primarily do in therapy is talk and listen. Whatever else that is happening between a patient and a therapist, we are clearly exchanging words. There is truth telling but a good deal of fiction, often supported by complex defenses, childhood fears, and other vulnerabilities. In the past, we would have said that such edited versions of self were only present in our clients. However, objectivity is a myth and therapists bring their own histories and vulnerabilities to the relationship.

At the risk of oversimplifying rather complex phenomena, one could make the case that psychopathology is caused by a failure of imagination. We can become "paralyzed by fact," as Lowell might put it, but also hindered in the accuracy with which we recall our past. We are all stuck in our own ways, within stories of loss, powerlessness, or other plots. The characters that populate the fictions in our minds transcend time and space. An aspirational goal for a therapist is often to help co-create new understandings and new patterns of relating--partly by generating new words, sentences, and stories. Questioning accuracy at times and putting a new spin on old memories. We involve ourselves in a co-constructive process of generating new meanings and new, associated affective experiences.

As storytelling creatures, we look for narrative coherence in the stories that surface in therapy. Our client's stories become fictionalized as we abstract patterns and integrate them into existing theories. This, of course, is quite helpful and facilitates treatment. Still, they may become, as Lowell might say, "blessed structures" of "plot and rhyme." In a recent talk, the psychoanalyst Adam Phillips proposed that in psychoanalysis "we need less theory and more interesting sentences."

Like poems, psychotherapy also has its own rules for punctuation. If words are, as Wallace Stevens has said, everything else in the world, how do we know when we have said too little or too much? The art of therapy involves choosing and titrating words with poetic care. There is the 50 minute hour, which provides a boundary as to how much can be said at any one time. This can be either frustrating or comforting, depending on the conversation. Then there is the question of how long treatment should last. Answering this question involves navigating the intersection of clinical expertise, patient satisfaction, and economic constraints. Of necessity, we face these punctuational realities at the beginning of treatment when we face questions like, "What will be left out if we only meet for 10 sessions?" Or, "Given a certain number of sessions, what shall we focus on?" The experience of therapy cannot, of course, be easily punctuated. It is no easier to ask when treatment has really ended than to ask when a painting or poem is finished.

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