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There has been a longstanding debate in psychoanalysis over the role of cognitive insight versus affective attachment in the process of therapeutic change. The terms of this debate are directly descended from Descartes's philosophical dualism, which sectioned human experience into cognitive and affective domains. Such artificial fracturing of human subjectivity is no longer tenable in a post-Cartesian philosophical world. Cognition and affect, thinking and feeling, interpreting and relating--these are separable only in pathology, as can be seen in the case of Descartes himself, the profoundly isolated man who created a doctrine of the isolated mind, of disembodied, unembedded, decontextualized cogito.
The dichotomy between insight through interpretation and affective bonding with the therapist is revealed to be a false one, once we recognize that the therapeutic impact of analytic interpretations lies not only in the insights they convey but also in the extent to which they demonstrate the therapist's attunement to the patient's affective life. I have long contended that a good (that is, a mutative) interpretation is a relational process, a central constituent of which is the patient's experience of having his or her feelings understood. Furthermore, it is the specific transference meaning of the experience of being understood that supplies its mutative power, as the patient weaves that experience into the tapestry of developmental longings mobilized by the therapeutic engagement.
But it can be a lot more complicated! For example, especially puzzling for therapists and analysts are situations in which the patient’s experience of being understood appears to be counter-therapeutic rather than therapeutic. A young therapist whom I was supervising presented such a situation to me, wherein her empathic interpretations capturing her patient’s emotional pain typically evoked rage from the patient. The therapist was completely baffled. I suggested to my supervisee that she ask her patient what she thought the therapist was up to in making such empathic comments. The patient replied, much to the therapist's astonishment, “You just want to get off on feeling superior to me! You comment on my pain so that you can look down your nose at me, your poor, pathetic, suffering patient!”
Whether a therapist’s expression of emotional understanding will produce therapeutic or counter-therapeutic effects will depend on the emotional meanings that such expressions have for the patient.
Reference
Stolorow, R. D. (2007). Trauma and Human Existence: Autobiographical, Psychoanalytic, and Philosophical Reflections. New York: Routledge, p. 5.
Link: http://www.routledge.com/books/details/9780881634679/
Copyright Robert Stolorow
