Clinical Techniques: #3 - Interpretation
It may be useful to begin looking at this topic by briefly contrasting the modern understanding of the uses of interpretation with the classical approach. According to Dr. Hyman Spotnitz (1985, p. 166):
“Primary reliance on interpretive procedures is a distinguishing characteristic of the classical method. ‘(t)he ideal analytic technique consists in the analyst’s doing nothing other than interpreting,”… (quoting Fenichel and others)…, and the goal of the analyst is to provide insight.”
Where do verbal interpretations fit in modern psychoanalysis? While our previous writings have underscored the importance of continual silent interpretation to a successful modern analysis; we have also alluded to the potentially ego-damaging effects of interpretation on many of our most vulnerable patients.
As the title of this article suggests, modern analysts do use spoken interpretation as a clinical technique; though the expectation is that they do so in a much more careful manner than previous generations of analysts.
When may verbal interpretation be used as a technique in modern psychoanalysis?
That answer depends on the analyst’s answer to another important question - Where is the patient at?
A rule of thumb that might be applied is that “(a)n intervention is of value only when it helps the patient move out of a pattern of resistant behavior that is being engaged in ‘right now.’” (Spotnitz, 1985, p. 252, emphasis original).
Thus, verbal interpretations may be used when the patient is ready for them, and when s/he will not be damaged by their use. In the “resistance to cooperation” stage, for instance:
“When the patient is really cooperative, he solicits communications that will help him verbalize spontaneously and uncover the immediate obstacles to this. Then it is desirable for the analysts to interpret and answer questions with a view to facilitating the patient’s understanding of the analytic process.” (Spotnitz, 1985, pp. 181-82).
Spoken interpretations may even help protect the patient’s ego at times. For example, one patient, deeply engaged in self-attacking behavior; and saying “My friends tell me I should just let it go. I don’t let things go. I just keep talking about the same things over and over, but nothing ever changes;” was told “Certain things may need to be talked about over and over.”
In this case, the patient’s immediate reaction showed the effectiveness of the intervention – the patient was reassured, less self-attacking, and thanked the therapist for understanding the patient’s need to talk about some things over and over.
Dr. Spotnitz, (1985, p. 276), says that in supervision of other therapists, he has sometimes given the following advice (regarding patients jumping up from the couch):
“… the analyst may make an interpretation pointing out the significance of his own behavior, such as ‘You jumped off the couch because I stirred up too much emotion.’ Such an interpretation tends to facilitate the verbalization of hostility by the patient.”
Spotnitz points out the goals of “maturational interpretations” as follows:
"Any type of intervention that helps the patient say whatever he really feels, thinks, and remembers without causing narcissistic injury (citing Lucas) is designated as a maturational communication…. At the other end of the continuum is the interpretation that is given when requested, and when it will help the patient articulate his own thoughts and feelings… The therapeutic intent underlying the maturational interpretation is to help the patient talk progressively…" (Spotnitz, 1985, p. 253, emphasis original).
The intellectual attractions of interpretation to classical psychoanalysts may have been the cause or result of a certain amount of hubris in the profession in the past. I do not mean to suggest that modern analysts are exempt from this; or that modern analysts might not “inadvertently” use verbal interpretations inappropriately.
A case that comes to mind is one where the patient previously related a long and painful life story to the therapist. Some time later the patient and the therapist had a “falling out.” The patient experienced painful feelings as coming from the therapist, but managed to verbalize those feelings, in spite of the fact that s/he and the therapist were not getting along with each other.
The therapist’s response was to say “Kind of like… (alluding to a previous incident in the patient’s life)". Rather than investigating, the therapist effectively ignored the painful feelings of the patient in this case, even while appearing to connect to them through the interpretation that was given.
What could have been happening? There are any number of possible explanations; the therapist may have been defending against the feelings, may have been thinking s/he would “help” the patient, may have been too self-absorbed to relate to the patient at that moment, etc…, etc… What seems most clear is that this therapist was missing something from the therapist’s own unconscious.
As we’ve discussed many times before, successful treatment most often depends on analysts being closely in touch with their own thoughts, feelings and impulses. This is why modern analytic training takes so long and requires so much of it’s psychoanalytic candidates.
Spotnitz, H. (1985). Modern Psychoanalysis of the Schizophrenic Patient: Theory of the Technique, Second Edition, NY, Human Sciences Press.
© 2008, James G. Fennessy, M.A., J.D.
Matawan, New Jersey 07747
Modern Psychoanalysis, Psychoanalysis