The irreducible subjectivity of the therapist

Freud (1919a) distinguished the "pure gold of analysis" from the "copper of direct suggestion", to differentiate psychoanalysis from other forms of psychotherapy and suggestion. This was linked to the concept of the "neutral analyst" and the idea of fostering the "transference neurosis" of the patient. However, as Gill (1982) contends, when the analyst does intervene, and even when not doing so, "he may be experienced as suggesting a direction for the patient to pursue" (p. 171).

Orange, Atwood, and Stolorow (1997) questioned what they term the "myth of neutrality" in psychoanalysis. They argue that "each time the analyst offers an interpretation that goes beyond what the patient is consciously aware of, he or she invites the patient to see things, if ever so slightly, from the analyst's own theory-rooted perspective" (p. 39). In the intersubjectivity model, by contrast, the analyst has no "objective position" from which she approaches the patient, and what is crucial is the ability of the analyst to be reflective in such a way that includes an awareness of the values and theoretical frameworks which guide him. Theory, or "internalised theory", more precisely, is not only a model for thinking, but has an important psychological presence, contributing, as Almond (2003) has argued, regardless of particular orientation, to "a sense of conviction, affective stability, reassurance and self-esteem" (p. 130). Criticising both the notion of neutrality and that of the "uncontaminated transference", intersubjectivists draw attention to the unavoidable organising principles of the therapist, including the proposal that transference can be understood as an "organisation", to which analyst and patient both contribute (Fosshage, 1994), a notion similar to Aron's (1996) insistence that the treatment is mutually constituted, but asymmetrical.

What then of the conductor's or analyst's contribution? Orange (1995) argues that the term "countertransference" needs to be replaced by "cotransference". In this view, the cotransference is defined as the analyst's perspective, with the argument being that it is often impossible to quite know what is "counter" to the patient's material, as if each party were independent of the interaction (McLaughlin, 1981). An apt question raised by Goldberg (2007), relevant to such arguments, is that of "who owns the countertransference"? Although Goldberg is specifically addressing publishing, and dilemmas surrounding the writing up of case experience, it can be seen as representing a wider philosophical question, once "mind" is no longer seen as independent substance, encased within someone's skin.

Not only this, but the analytic dyad, and the therapy group, do not exist in isolation from a wider organisational and social context that also nourishes and influences the relationship (Zeddies & Richardson, 1999).1 Orange (1995) thus declines the temptation to ground some ultimate objectivity in the lone authority of the analyst. A group analytic, and certainly sociological, view might be that the authority of analysts (individual or group) is simply a product of specific historical networks of relations.

Beyond the particular theory the analyst or conductor may hold— and it is interesting to speculate why different therapists gravitate towards a preferred model—there are wider (or deeper) values which influence conduct and thinking. All clinical exchanges involve some communication of values between the patient and therapist, expressed by verbal and non-verbal means. Lichtenberg (1983) argues that the point is not that the analyst can ever become value-free (or theory-free), but that he can become more value sensitive. This is where the concept of the "social unconscious" has an important clarifying role, helping us to better locate our patients and ourselves within a cultural matrix and attendant world of values that help produce us.

 
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