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Psychotherapy of the Young Adult: The Fallacy of UnderstandingBy Edgar A. Levenson
Reprinted with Permission of Contemporary Psychoanalysis and the William Alanson White Institute
Oscar Wilde once said that it was only shallow people who did not judge by appearances. The mystery of the world, he added, is the visible, not the invisible. This essay is just about that, the visible and observable. It is, in essence, a claim that the core of psychotherapy lies in the recognition of pattern, the formal structure of events that constitutes what might be called the aesthetics of experience, aesthetics not in the vulgate sense of beauty and light but more precisely, sensitivity and perception, that is, that concerned with the forms and organization of sensory experience rather than content and meaning.
The younger generation lives in a world oriented aesthetically whereas we are still concerned with understanding and insight. Moreover, the famous generation gap looms between us and the entire contemporary culture of which these youngsters are part: arts, values, technology, and even science. So, inquiring into young adult behavior is intended not only to help a specific group of patients but also to orient ourselves in a rapidly changing society where the dangers of "old fogeyism" are as real for psychotherapists as for parents.
Professionals reading papers on youth are much given to quoting cranky inscriptions from Ur of the Chaldees or ancient Egypt attesting to the churlishness and ingratitude of the younger generation. "I see no hope for the future of our people if they are dependent on the frivolous youth of today, for certainly all youth are reckless beyond words… When I was a boy we were taught to be discreet and respectful of elders, but the present youth are exceedingly wise and impatient of restraint." Except for the rhetorical style, that could be Johnny's dad, or Ronald Reagan, but it is Hesiod, "rapping" in the eight century B.C.
We have on critical advantage denied the ancients. Cultural and technological change have accelerated so remarkably that, for the first time within a person's lifetime, it is possible to achieve perspective.
The Taoists say you cannot speak of ice to the summer insect. To recognize change, one must either live long enough or things must move fast enough. We are, hopefully, at that latter point for, as the anthropologist Weston LaBarre (1954) pointed out, man has shifted his evolutionary development from his own body to his environmental extensions; in so doing he has tremendously accelerated the evolutionary process. Biological evolution has been supplanted by technological evolution. Man's uniquely human propensity for molding and changing his environment rather than himself has resulted in an entirely new dimension. He has become the animal that creates his own environment, indeed his own biotype.
Unlike other animals, whose evolutionary developments eventually box them into environmental rigidity, man can, unless he blows himself up, extend indefinitely, not adjusting to an ultimately limiting environment, but making his own environment. The bird perfects the wing, the porpoise the low-frictional surface, and they must then live within their limits. Man does not perfect, he invents, and each technological advance thrusts outward, widening his range and changing his world. He has extended language through the technologies of writing (papyrus, stylus, paper, block printing, Guttenberg press, photocopying). He has extended his musculoskeletal system thru the lever, wheel, and machine (manual, hydraulic, gasoline, electric). He is now in the process of extending his central nervous system, again by technological means, into the outside world using vacuum tube and transistor (that is, electronic devices) and, the latest technology, the laser (that is, pure light).
You may recognize the concepts of Marshall McLuhan (1964), that stormy petrel of the new sensibility. One might balk at his apparent oversimplifications, but unquestionably there has been a continuous extension of man's technological skills, each of which works a radical change of his environment and his ways of thinking, feeling, and valuing. To quote McLuhan (1964, p. 3), "During the three thousand years of the mechanical age we extended our bodies in space; today, after nearly a century of electric technology we have extended our nervous system itself in a global embrace, abolishing both time and space as far as this planet is concerned. Rapidly we approach the final stage of the extension of man - the technological simulation of consciousness." Absurd? The work on rapid eye movement sleep is an early step, an electronic technology bringing, for the first time, dreams outside the dreamer's head. It is not beyond the realm of technological possibility that we shall, some day, be able to project the dreamer's dream on a screen or with the newer laser technology project a three-dimensional picture, a hologram.
Changing technology, then, may be considered as an evolutionary environmental extension that creates its own world. The prevalent technology will pervade every aspect of the culture: its science, literature, arts, even is concepts of social and psychiatric aberrancy. Thus, even apparently disparate aspects of any culture will be found to share what Kuhn (1962) called the paradigm of the epoch. It has been said that we do not know who discovered water, but we do know it was not a fish: The paradigmatic consistency is so pervasive and encompassing that we are largely unaware of our immersion in it.
Freud was as much part of the mechanical paradigm of his time as was Newton or Marx. The prevalent technology was an extension of the musculoskeletal system, the work machine. Its social consequence was the first industrial revolution. It will be noted that in the mechanical paradigm, from muscle to automobile, energy is processed, transformed from one form to another. Scientific theory of that paradigm reflects that concern with energy transfers, the mechanics of transformation, and the clockwork dependability of process. In Newtonian physics, as in Freudian psychodynamic, processes are reducible to basic, precisely interlocking mechanisms that are reversible, that is, they run either forward or backward. Thus, in Freud, his metaphors are of drive, energy transformation, force and counterforce, the hydraulics of depth, pressure, and repression. Since processes are reversible, regression and fixation become points in the machinery cycle. Most important, therapeutic cure is a reversing of the pathological machinery (Levenson, 1958). since there is a purpose and motivation in human behavior, teleology had to be established (a driver must be found). The Cartesian ghost in the machine is invoked; thus, resistance, transference, unconscious motivation.
We are, at present, immersed in the electronic paradigm. Its technology is an extension of the central nervous system, and its machines process not work but information. Even such contemporary work machines as jet aircraft, rockets, and complex industrial machinery are dependent on electronic servomechanisms. Its social consequences is what Anatol Rapoport (1968, p. xix) called the second industrial revolution, namely, automation. We are now living with its consequences. From brain to computer energy exchanges are infinitesimal in the electronic world. Processes are statistical, contingent, irreversible, singular. Cybernetics, for example, does not examine transformations of energy. It examines patterns of signals by means of which information is transferred within a system. Quantity of information is central, and unrelated to its meaning, truth, or significance.
Concern, then, is not with the mechanics but with the organization of information, namely, pattern. This contemporary model underlies modern statistical physics; general systems theory and its implications for psychiatric theory have been examined by Shands (1968), Grinker (1968), Ruesch and Bateson (1951) and Buckley (1968). There has been a very considerable effort in psychiatry to replace the mechanical language with a more contemporary lexicon; thus we find concepts of feedback, transaction system, double bind, mystification. However, more often than not the metaphor is changed but not the paradigm. The imagery is different, but the larger cultural assumptions remain the same. The therapist's view of the symptomatology of the patient, his "diagnosis," the goals of therapy, may reflect the old paradigm. It is a bit like teaching a Solomon Islander to drive a jeep: The old world learns to master the new by rote.
The new is often dealt with by incorporating the language without changing the concepts. We need a view of the patient and our relationship to him which is routed in the new paradigm. Young adults are a particularly felicitous group for this kind of inquiry, since the are children of the brave new world and particularly irritating and incomprehensible to those of us, paradigmatic anachronisms, who try to see them and their world (dress, hair, music, values) in our terms.
Now, the cultural manifestation of the electronic paradigm is aesthetics, aesthetics, as I defined it previously, being concerned literally with perceiving, sensation, and the patterns and forms in which this sensory experience is cast by the observer. The traditional distinction between form and content is abolished. Form becomes, in Susan Sontag's terms (1961, p. 35), an epistemological decision, an interpretation of how and what we perceive and content becomes a variety of form.
We are no longer as interested in the machinery as we are its patterns of consequence. If insight, Freud's primacy of the intellect ("put the driver in the driver's seat"), is the therapeutic goal in the mechanical paradigm, then expansion of sensory awareness (turn on, tune in, experience) is the goal in the electronic paradigm.
We have, in a sense, rediscovered the tribalism of the primitive who goes into ecstasies over the polyrhythms of an automobile backfiring without the slightest interest in its mechanics. Contemporary art manifests the same interest in the aesthetics of an object apart from its internal machinery or function; thus, a crushed automobile can become a work of art.
Much of the exasperation engendered in us by young adults can be traced to this change in paradigm. We tend to think of their language as incoherent, stereotyped with endless repetitions of "uhs, ahs, like you know man…" It has about as much content as the beeping of dolphins. But it is a highly formalistic, structured communication system in which the pattern is more important than the content. After all, one could build a computer language around "uhs"; we send telephoto pictures from one end of the world to the other, using only a dot. Young adult humor is equally alien: "What is purple and hums?" Answer: "an electric grape." "Why does it hum?" "Because it does not know the words." If you do not think this joke is funny, you will never make a computer programmer. You are content oriented, uncool.
The electronic-aesthetic paradigm is evident in their lexicon: "Turn on," "turn off," "blow your cool" (even "beautiful," as the highest accolade.) As C.D.B. Bryan (1968) pointed out, their morality is based on aesthetic rather than social values: "If it's beautiful, do it." When informed that high decibel levels of noise cause permanent deafness, one discotheque owner said that he would list the daily decibel level outside along with the temperature and humidity. In horror, we assign that hoariest of old-fogey epithets, "amoral." Yet, it is nothing more than respect for idiosyncrasity, the privacy of pattern, "doing your own thing." Perhaps our Protestant ethic of work is too machinery oriented. Work is, after all, an energetic definition. We may need a new ethic of role, one's place in the pattern of things. Oddly enough, the Protestant ethic led to the sweatshop and contempt for the shiftless. The new amorality seems to have led to social consciousness and the Peace Corps.
I might add that when I talk of youth culture, I do not mean to imply that this is a general manifestation. The great majority of young people, in statistical terms, live quite comfortably in the old environment. I am limiting myself to those young adults who, for a variety of complex determinants, are tuned into the new sensibility. They are not all successful in it; some of them, like the canaries miners carried into coal shafts, are destroyed by their prescience.
There is, then, a greater concern with formal structure than content in the youthful ethos. And, when one is concerned with idiosyncratic patterns rather than basic, commonly held machinery, a high premium is put on uniqueness. "Doing your own thing" is a paen to uniqueness, or style. In the movie The Graduate the hero looks like Kafka's cockroach, but wins the girl away from the handsome medical student, who is a cliché of everything desirable in American youth. Banality, not ugliness, is the cardinal sin of aesthetics.
We, on the other hand, content-oriented vestiges of the mechanical age, want to know, to understand, what it really means. We are hopefully too sophisticated to ask of an abstract painting or Theatre of the Absurd, "Yes, but what does it mean? What did the author try to say? What is his message?" But we ask the self-same questions in therapy. Sympathetic adults who want to understand get the same short shrift from these kids as the white liberal who wants to understand the Negro militant. Understanding is, in these cases, a dissection. It fails to respect the separateness and inaccessibility of human experience. It boils the person down to a set of commonly held universal mechanisms. If happiness is a warm puppy, then love may be the capacity to enjoy it without taking it apart to see what makes it tick.
One must understand clearly that these are not simply metaphors but paradigms, all-pervasive models, imbedded in a concrete technology and that this technology is in rapid evolutionary flux. Otherwise, one can easily fall heir to the horseless carriage fallacy, the nothing but fallacy, namely, the automobile is nothing but a mechanical horse, the new technology is nothing but an extension of the old. Rather, the automobile is a radical extension of human control of space and movement, which has created an entirely new environment; one need only visit California, the most highly realized automotive society in the world, to appreciate that. To say that Sullivan's parataxic distortion is nothing but restatement of Freud's transference distortion is to miss the point. The paradigms are entirely different. To criticize a particular concept as shallow, lacking in depth, or not dealing with basic drives may simply be a matter of one's paradigm showing.
I suspect that this was a continuous burden for the great innovators in psychiatry. Freud and Sullivan were essentially great artists, what Rilke and McLuhan (Sontag, 1961 p. 35) called, in slightly different words, experts in sensory awareness (I presume this is an aesthetic definition). They were also, by virtue of their profession, teachers, since they, perforce, had to translate their immense clinical sensibilities (which is what initially attracted proselytes to them) into message. The language of the expert is often one cultural epoch behind the sensibilities of the artist. With both authors, one has very much the sense of brilliant innovators struggling to keep their intuitions viable within the nothing but language of their particular science. Freud attempted to surmount the problem by great literary style and classic analogy; Sullivan virtually invented a new language. In the end, both men despaired of being understood, and rightly so. No man is prophet to the next generation and his followers, alas, become the apostles of the obvious.
If you will entertain my premise that young adults reflect a new paradigm, and that aesthetic considerations are the social homolog of the electronic environment, what does this position offer the clinician? Models of exact science, Newtonian physics, or general systems theory are of great value to the theoretician, but for the grass roots therapist they are about as consoling as reading Kierkegaard on one's deathbed. The aesthetic homolog is simpler and, I think, more human. What if we eschew understanding and ask instead what is the patterning, how is it structured, what relationship does one event have to another in this person's life?
First, you will note, that we are asking how people different rather than alike. Metaphorically we are more interested in their appearance, fingerprints, voice patterns (anything unique) than in their common biological heritage (one heart, two lungs, the parts depot on nineteenth-century taxonomy). Second, we are interested in the particular patterning of the person's life, necessarily the recurring patterns. Interestingly enough, and consistent with my thesis, Ludwig von Bertalanffy in his general systems theory (1968 has equivalent terms - perspectivism and isomorphism. I am, of course, using these aesthetically rather than scientifically, but the congruence of concepts, the common paradigm, is apparent. In von Bertalanffy's (1968, p. 55) words, perspectivism implies that it is arrogant and parochial to consider our own form of experience as a singular point, a facsimile of the real world, while relegating other - for example, the mythical, the Aristotelian, the artistic, the mystical universe - to the realm of fancy and delusions. Rather, we should recognize - in line with psychological research, critical philosophy and modern physics - that each world view is a certain perspective of unknown reality, seen through the spectacles of human, cultural and linguistic categories.
Smiling at monkeys, as any visitor to an Indian temple can attest, is a serious matter. One is very likely to be bitten. For, in the simian world, baring one's teeth is a statement of aggression. The monkey and the aesthetician agree: Form is, indeed, content. Is the monkey paranoid? Not at all. He simply has a different experience, a different vocabulary of behavior. That my intent is benign is entirely irrelevant. The meaning of my message lies in your response. If the monkey could talk, being Indian, he could refer to the Vedanta: Cause and effect, it says, are the same event observed from different vantage points. Too often, we tend to confuse intent with effect, meaning with consequence.
We show the monkey more charity than we often show our families, friends, and patients. If I notice that every time I show warmth toward you, you beat a hasty retreat, I am merely observing a pattern of transaction. I may note that it recurs consistently under certain circumstances, or that variations of this pattern occur or have occurred in different aspects of your life. But I cannot say with any conviction that you are a person who retreats from intimacy. Can I be sure that I am offering intimacy, or that it is appropriate to your needs? What is your experience of my warmth? Another therapist, treating the husband of my patient, said, "I think he really loves his wife, but she is such a cold, paranoid person." If she is really cold, then he only wants the experience of being loving. If he really loved her, would she be cold and paranoid? In the old paradigm there is his machinery/her machinery, stimulus/response; the husband is Mohammed trying to move the mountain. In the new paradigm, they make a pattern. It is not our job to know who is "truly loving, truly related, truly rejecting." This kind of understanding is a reification of experience, as Lasing puts it, a destruction of the other person's experience. Sartre, in St. Genet (1964), a study of the aesthetics of perversion, said that "Evil is the systematic substitution of the abstract for the concrete," in my terms, the substitution of understanding for awareness, of insight for sensitivity.
Parenthetically, Sullivan's and Fromm-Reichmann's effectiveness with schizophrenic patients hinged on this awareness. Perspectivistically, one could wonder at the structure of the hallucinatory experience. Under what conditions did it occur, what form did it take, what feeling accompanied it? If it occurred with the therapist, under what circumstances. The schizophrenic experience is regarded as real for the patient and relevant to his life. They made no effort to understand hallucinations in terms of an internal machinery, nor did they attempt to understand the experience of anxiety that accompanied the hallucination. They knew that to be the ineluctable domain of the schizophrenic person.
If the first step in the assessment of structure is perspectivism, the second is isomorphism. As we attempt to elaborate the patterns of behavior and the consistent relationships of these patterns to different aspects of the patient's life, we see that there are not only enduring patterns but a remarkable homology of pattern, over and over in every aspect of the patient's life. The same structure runs through language, past history, present behavior, fantasies, dreams, and behavior in the therapy room. Recognition of this isomorphism was at the core of Freud's clinical perceptions. Indeed, the ability to detect and elaborate isomorphic patterns, regardless of the metaphor, may well be at the core of therapy or for that matter, any creative process.
It is possible, very much as Levi-Strauss (1963) did with primitive cultures, to delineate very consistent structural relationships between dreams, fantasies and behavior. Jones (1962), for example, did exactly this with patients' dreams, relating the structure (not content) of the dream directly to Erikson's epigenetic levels. Erikson suggested that a dream should be studied not only in terms of its figurative content but also in terms of its configurative forms. Jones was able to demonstrate a consistent structure in patient's dreams and a shift in the relationship of epigenetic residuals as the patient improved in treatment. One does much the same in connecting a patient's anal imagery in a dream, his characterological stubbornness, and his fastidiousness. In other words, all therapists look for isomorphic patterns. And, when these patterns occur in the therapy room, we capitalize on the opportunity to demonstrate to the patient the machinery of his "distortions." Isomorphism is considered classically a machinery of replication, to wit, the repetition compulsion. The patient is presumably unaware of his machinery of at least of its pervasiveness.
I would go three steps further. (1) There is a continuous ongoing isomorphic recurrence of the patient's patterns in the therapy room not just under conditions of anxiety. (2) The structure of the relationship between the patient and therapist in any given session is a homolog of the content of the session. A supervisor given the content of a session could predict the direction and affect of the therapist-patient relationship. I am talking now of form not content. (3) The isomorphic experience is real; it is not the patient's distortion or, for that matter, the therapist's.
Man, it will be recalled, is the animal that creates his own environment. Indeed, Sullivan (1956) defined the self-system as "a series of linguistic tricks by which we keep our world satisfying." Assuming a certain passivity on the part of the therapist (guaranteed by his relative anonymity, the fee arrangements, and psychoanalytic technique) he will become part of the patient's psychological surroundings, his environment. The patient will create the therapist in his own image. As Tauber (1954) pointed out, one can utilize this curious experience of being the patient's invention. By noting one's participation (in fantasy or action) one can learn not what is wrong with you but who the patient is and who you have become. It is very much as the tourist in a foreign land expects to be cheated, becomes increasing hostile and insulting, and is in reality finally badly gulled. Is he imagining the abuse? Is he then justified in saying the foreigners are cheats? Perspectivistically, the issue is not whether the patient's experience is real or imagined but rather the structure of his world and the particular form he impresses on events. The question for the therapist, then, is not "Why do you see me that way?" but "How did we get into this real and familiar fix?"
There is an old psychiatric joke that goes: "What is a sadist?" "Someone who is kind to a masochist." To a masochist any behavior is sadistic. What is more, any therapist working with a practicing masochist will become sadistic. This is not countertransference, a failure of analysis or moral fiber, but a realistic consequence of entering the other person's world. Now, within any given session, there will be a similar formal integrity; that is, all the events of the sessions, reported and observed (dreams, experiences, fantasies, transactions of therapist and patient) will share the same form, will be part of a whole. Thus, regardless of the therapist's system of hermeneutics (his content) the patient will hear only what is consistent with the session. Let me give a familiar example: During the session the patient complains about his inability to defend his own interest, his victimization by others, his dependency and passivity. His ingratiating his behavior is followed by, let us say, a partially dissociated rag and self-destructive acting out. The session ends, the patient head for the door, turns, and says, "Oh by the way, Doctor, I can't come in next week. I have to study for a series of exams," or "It's the only time my wife and I can go on vacation." The inexperienced therapist smiles lamely and says, "Well, O.K. Have a good time." The seasoned campaigner might insist he come back to discuss it, refuse to let him off, casually inform him he must pay, and so on. He will be outraged or hurt. Or, perhaps, relieved that the therapist is not malleable, he may learn by example that one can dare to court rejection. He becomes a reformed masochist. God knows, there is no prig like a reformed masochist, but we hope he works it through and levels out. Supposing, instead, we point out to him that the pattern of his exchange, the form, regardless of the content, is to complain bitterly about some disability, engage the other person's support or at least sympathy, then hoist them on exactly the same petard. But, could not the patient then say, "Look, you encourage me to be assertive, but see what happens when I try. You jump down my throat." Ask him why he waited till the end of the session. He may say that he was too timid to ask before.
The therapist, depending on his metaphor, will interpret this exchange variously. The patient's behavior can be seen as testing, acting out, or a first timid assertion. One therapist would say that the content of the session is followed by an acting out of conflict. Another might say that he brought up that content only because he was preparing to ask for a vacation and did not dare without first preparing the therapist, binding him to a sympathetic position or whatever. Perhaps he is asking for a sadistic attack, or a show of strength. This scatter of interpretive postures will be familiar to anyone who has attended a clinical case seminar or had supervision.
The therapist then has defined his own structure and has required that the patient become part of his environment. He has told the patient who he is in the therapist's world: pathetic, tricky, ruthless, exploitative lovable, unlovable. Even if he maintains absolute silence, that refuge of the very good and very bad therapist alike, he has invented the patient. It is a psychiatric aphorism that Freudian patients dream of penises, Jungian patients dream of castles, Frommian patients dream of love. Getting well can be becoming what the therapist makes of you, what Fromm called "reform."
The patient learns the therapist's metaphor. He does not hear the content because it is irrelevant. Being more contemporary than his therapist, the patient may learn the therapist's patterning, whereas the therapist learns only the content of the patient's communication. Your behavior really means that if both therapist and patient were aware of the recurrent patterning of the patient's experience with authority, requests, or indulgence, they would note that whatever the therapists says or the patent says, they will be reenacting the same pattern.
This Gordian know can only be unraveled by an exchange of experiences. The patient must become aware of what he was feeling at every step of the exchange. The therapist must be equally aware of his responses, though whether he informs the patient will depend on his own rules of therapy. An expansion of sensory awareness is then the first step. Having delineated the pattern of their experience, therapist and patient can begin to look for the homologies in other aspects of the patient's life: dreams, social behavior, fantasies, history. In other words, one accumulates as much sensory experience as possible and then patterns it. Ideally, one could do the latter without any other knowledge of the patient. Perhaps that is how really brilliant intuitive therapists work. The rest of the us try to resonate to the rhythms of the other's experience. Sensory awareness and pattern-making may be the heart of therapy: will note these two dimensions have also been defined as the process of creativity. Perhaps, in an aesthetic paradigm, cure is an aesthetic experience. Edel (1959, p. 133) said that it is the novelists and poets who have a feel for "the sensibility with which the outer world is appreciated and felt." Freud, by his own admission (Roazen, 1968, p. 53), was more an artist than a scientist, though he considered it a regrettable shortcoming.
This is the dream of a woman in her twenties. She is watching a brightly lighted stage. There is a play in progress. The audience is sitting in the dark. She, herself, is not in the audience. There is an aristocratic lady sitting at stage right. There seems to be a play within a play being performed to entertain her. A series of richly decorated possessions are being paraded before her. The lady does not seem gratified. She sits impassively. At the front of the stage there is a team of caparisoned horses of the sort used in weight-pulling contests. They are prancing about, and the patient thinks they are too close to the edge. She feels that she should do something, perhaps call out, but she does not move. The horses go over into the orchestra pit, pulling the groom with them. She thinks, my God, he will be killed. Oddly, there is no sound, as though the fall were somehow not completed. The expected carnage does not materialize. The dream ends. There are many possible interpretations of this dream, depending on one's predilections. But, suppose one examines the form of the dream. First, the dreamer is at great distance, doubly removed, that is, not in the audience, which is itself in the dark; there is a play within a play. There is an effort to involve a detached queenly woman, who can be neither gratified nor really distressed. The collapse of the work horses, the overthrow of the groom, have no consequence. The dream ends with nothing really happening. Now, this form will surely be repeated in her family history, her behavior outside the therapy room; in the traditional sense it reflects her characterological style. But within the session in which the dream is reported it will predict the course of the session, the form (not the content) of the therapist's efforts, and her reaction.
We can predict that she will remain at a distance from her own dream. The therapist will be provoked into an elaborate effort at interpretation which will be received politely, his effort will be sabotaged, and quite likely, neither he nor the patient will be aware of any annoyance or distress. If he becomes aware of her resistance and points it out to her, it will become only another futile effort in the play within the play. The dream being reported and the session have the same isomorphic structure. The therapist is doomed to play out this role of the unsuccessful entertainer; the patient plays out her part as disdainful lady.
In actuality, the therapist made such an interpretation, the patient rejected it by showing polite interest. The therapist responded by pointing out that she was behaving as the dream predicted. She became irritated. The therapist stopped to examine his feelings. He was feeling really hurt, insulted. He felt that the patient encouraged his performance and then never seemed impressed or grateful. These feelings were stated, not as fact buy simply experience. She responded by her feeling that she was supposed to admire the therapist's cleverness, applaud him. From her point of view, it developed that the panoply, the artificial display on the stage was more to the point than the lady's disdain. Her life experience had been with virtuoso intellectual performers (men) toward whom she was expected to behave with admiration and approval. The therapist now understands that to be clever with this woman is a fatal flaw. Had he misinterpreted the dream? Was it a statement of his countertransference, her resentment of his need to demonstrate prowess? Yet, the therapist feels something withholding in her silence. It is not as though she feels what she is being given is worthless; rather she will not admit that is of value. This is checked against her perceptions. When the patient learns that the therapist is not interested in fitting her to his metaphor, but rather "brain-storming," freely exploring sensory responses, she is rather likely to help out.
When one has extended the limits of sensory awareness, one attempts to pattern the mutual experience. If the patterning is correct, the isomorphic replication of past and present will become evident, and both patient and therapist will have a sense of completion, of aesthetic wholeness in the design. This does not cure. It does educate her in a method for extending awareness and gives her a sense of the idiosyncratic structure of her life. She hopefully will be able to see how she creates her own environment. The experience with the therapist was a homolog of the patient's experience with her father. But he had never been able to tell her what if felt like to be on the other end of the exchange. She did not have sufficient data to structure her experience. In this perspectivistic framework, it is not important to know whether the therapist's response to her was rational, neurotic, or appropriate. All that is necessary is that one person know what the other feels and acknowledge that the response is relevant. The goal of the analyst's own training should be not to make him free of distortion but free to use his perceptions on the premise that any repsonse is useful as long as it is authentic. Let us take a last clinical example using a rather classical dream. A woman struggling with her relationship to her husband dreams that she has bought a summer cottage. It is in terrible shape, but particularly the kitchen is very poor. The floor is covered with filthy worn linoleum; the sink is rusty, dirty; the stove is ancient and encrusted. She things, if only I could scrub it up, it would not be so bad. She goes outside; all the trees are dead, stunted. She walks over to one forked tree, sees that cement had been poured in the crotch of the tree and one half is still alive. She thinks someone has repaired the tree, things cannot be so bad. She feels cheered. The metaphor of the mutilated tree with cement in its crotch would delight the heart of a first-year resident in psychiatry. It makes one feel there must be something to the castration complex and penis envy!
There is no doubt that that is how she sees the female condition. But the structure of the dram also suggests her behavior in the face of this feeling. She accepts the condition, tries to tidy up, settles for small signs of life, accepts the radical castrating surgery of the tree as benign. One could predict that in her present life and in her therapy she experiences herself as driven into a role that is degrading, but which she must accept in good grace. Now this woman and her husband are both in private treatment. The four participants meet for a once-weekly session. It was evident to both therapists (she had been discussed before her dream) that in the joint session that preceded that dream, she had in fact been excluded and that a quasihomsexual community of the men had been set up to her out. She had no conscious awareness of that exchange. To interpret her feeling of penis envy or exclusion would be worthless, without her awareness of the actual events in the joint session. But even that will be greeted with resentment at the exclusion, now acknowledged, and humiliation that she was not able to see it without male help. It would be the boys letting the little girl play because her feelings were hurt. She was able to identify a number of marginal cues she had experienced in that session that could have alerted her to her feelings. She must learn to listen to her promptings, develop awareness, and contribute her own sense of structure to the sessions. The therapists and her husband treat her with contempt because she does act stupid. She acts stupid because everyone is too guilty to accuse her of acting stupid. When she is responded to authentically, she responds differently. The event is like a pebble dropped into a pond of awareness. The circles spread endlessly. If one stops at any point and says this the truth, here is the real motive or understanding, one reifies the patient and automatically falls into the trap of playing out the very material under examination. How can a therapist with contempt for a woman talk to a woman about her penis envy? How can one not have contempt for a woman for someone who treats herself stupidly? Will one's own analysis solve that problem? To think that one will never again feel contempt for a contemptible person confuses beatification and analysis.
To the therapist schooled in the mechanical paradigm this will seem overly simple, or perhaps "nothing but." In the machine model, breakdown occurs when the machine fails to work, clunks, or leaks oil. The mechanic repairs it, returns it to its previous level of function, perhaps a bit more finely tuned. In the electronic paradigm, nothing really happens. Information is exchanged, possible patterns of the information are tested for isomorphic recurrence. The therapist functions only as an expert in sensory awareness. Sullivan (1954) cautioned the therapist to limit his performance to being an expert. It is enough. It is not required that one cure the patient. Change results not from fixing something buy simply from feeding more information into the system, acting as a consensual validator of the patient's experience and aiding in the delineation of homologous patterns of experience in the patient's life, including his experience with the therapist. One might say that the patient improves because of a new experience, an authentic exchange with a therapist who responds honestly and openly. But the openness and authenticity can be experienced by the patient as a seduction, an exploitation of the patient's wish to trust. With young adults, this is particularly true, since the therapist is often tempted to signal, "Look, trust me, I am honest and open and not like your parents." Thus, the therapist's vaunted authenticity can become nothing more than an isomorphic repetition of the parents' "We will do anything to show we love you."
The corrections of interpretations ceases to be relevant. There are many different formulations possible for any observable event in therapy. But primarily one tries to enrich the aesthetic banality of neurosis. If a patient understands himself with great clarity, but cannot entertain another perspective, another possible way of patterning his life, then he is like the philistine who has learned to like opera or abstract painting. Neurosis requires a very low level of sensory awareness. Great sensory awareness without patterning or with simplistic patterning runs the risk of paranoia. To be aware is to be endangered. Henry James (1951, p. 402) said, "the power to guess the unseen from the seen, to trace the implications of things, to judge the whole piece by the pattern, the condition of feeling life in general so completely that you are well on your way to knowing any particular corner of it - this cluster of gifts may almost be said to constitute experience."
Accordingly, the difference between a good therapist and a duffer may be not how the formulates things, but whether he sees them at all. To put it more succinctly, the experienced therapist enriches information, the beginner enriches metaphor. We have always referred to exceptional therapists as "talented", for we have instuitively recognized that the core of therapy is artistic. Great sensitivity and pattern-making are talents, not taught skills. We should in our selection and training of therapists look for those abilities and develop techniques for nurturing them. Unfortunately, out of our need to be scientific we have developed elaborate systems of hermeneutics. In our present society, science and aesthetics appear to be undergoing an unexpected confluence. Perhaps we can at long last use an unscientific language without being unscientific.
According to my young patients, we are already untrustworthy and approaching senescence. Let us try to keep our concepts uncalcified and our language young.
Notes
1. Singer (1951 and Ch. 14, this book) has done some
quite novel and pioneering work on the relationship between neurosis and
perceptual insensitivity.
References
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Rapoport, Anatol. Foreword to Walter Buckley, ed., Modern
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Roazen, Paul. Freud: Political and Social Thought.
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The Social Matrix of Psychiatry. New York: Norton, 1951.
Sartre, Jean-Paul. Saint Genet. New York: Mentor
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Shands, Harley C. "The Revolution in Communication."
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Singer, Erwin. An Investigation of Some Aspects of Empathic
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