Toward a model of the therapist

In working with neurotics, the therapist must always express a desire for patients to continue, even if he or she feels that these patients have completed their work.  Such patients will break off when their own desire to move on has become strong enough and determined enough.

…This obviously implies that the analyst is an actor or actress who plays a part which does not necessarily convey his or her “true feelings.”…The analyst may find a patient unpleasant and annoying, but of what use is it to let the patient know this?  The patient may very well react to an expression of the analyst’s antipathy by leaving analysis altogether, or by trying to make him- or herself pleasant and interesting to the analyst, censoring certain thoughts and feelings which he or she thinks might annoy the analyst, instead of getting down to true analytic work.  Counterproductive reactions to say the least!  The analyst must maintain a position of desire — desire for the patient to talk, dream, fantasize, associate, and interpret — regardless of any dislike he or she may have for the patient.

That is from Bruce Fink’s often quite interesting A Clinical Introduction to Lacanian Psychoanalysis Theory and Technique, which I suppose also doubles as management advice.

By the way, here is today’s (closely related) David Brooks column.  Alex passes along this link.


Do therapists acknowledge their problematic position(s)? At least in confidence?

all else in place, most certainly. i had a regular therapy session going on for a few years. within the first or second session, i was already asking her how she handles patients she didn't care for, etc. i felt she was honest enough to take seriously.

Do you find Lacan intelligible and/or enlightening? I did a lot of critical theory in college and I found him to be among the most opaque and unrewarding writers I encountered.

"Hippocrates once observed, “It’s more important to know what sort of person has a disease than to know what sort of disease a person has.” That’s certainly true in the behavioral sciences and in policy making generally, though these days it is often a neglected truth."

good grief. I'm sure there are a million problems with the way modern psychiatry is practiced and marketed. But I think the "uncertainty" that exists in psychiatry is far better than any "certainty" expressed in an opinion piece like Brooks's.

One's opinion on that probably depends on whether you've ever tried to get help for feeling blue and were kidnapped by psychos or shot by cops.

But this doesn't answer the burning question of which therapists are paid more - those from GMU or UVA?

Great article by Brooks.

Many therapists won't take insurance except for a few hard luck cases. So ability and willingness to pay are the selection criteria. Why would therapista cut off their own cash flow? One can always justify a continuing need for therapy.

Therapists are also often afflicted with the same neuroses as their patients. The suicide rate for therapists is fairly high among medical practitioners.

In a sense, psychology and economics seem to have forgotten the same critical component that belongs to a healthy organism: freedom of movement.

Didn't this "Toward a..." business go out of style by the early 70's? It was all the rage back then.

Contra Brooks I think the "heroes of uncertainty" are the people not the professionals ... living with shocks and bitter pills (in health or finances) is harder than diagnosing or treating those ills.

"The analyst must maintain a position of desire — desire for the patient to" keep paying.

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