Det tempererte nærvær: En teoretisk undersøkelse av psykoterapeutens subjektivitet i psykoanalyse og psykoanalytisk psykoterapi

Abstract

This is a theoretical dissertation. The main topic has been to study the influence of the psychoanalyst’s or psychoanalytic psychotherapist’s subjectivity. The psychotherapist’s subjectivity is not defined precisely, because another objective has been to encourage a reflection around this concept, and try to study how the “psychotherapist’s subjectivity” can be a sensitizing concept which can point in one direction even without being operationalized very cogently. To say something about the direction in which this concept can sensitize us: the psychotherapist’s subjectivity is about what’s unique and particular for one single psychotherapist, that which can’t be generalized, the things that this psychotherapist don’t have in common with other therapists. But it is also about the things that are most important for the therapist, what’s valuable in his life, the things that forms his life, his personality, his unconscious. To say that this is a theoretical dissertation or investigation means that it rests on a dialectical exchange between a theoretical study of literature and a personal reflection on my own clinical practice as a psychoanalyst and psychotherapist for both children and adults. This dialectical exchange is very important. A central epistemological claim in this investigation has been that theory and practice are closely connected in psychoanalysis and psychoanalytic psychotherapy. This study has four main questions: - How does the psychotherapist’s subjectivity manifest itself in the psychotherapeutic situation? - How does the psychotherapist’s subjectivity influence the psychotherapeutic situation? - How can the psychotherapist use his subjectivity to the benefit of the psychotherapeutic process? - Is it possible to investigate and/or develop the psychotherapist’s subjectivity? The epistemological basis of this investigation has been influenced by ontological hermeneutics, phenomenological reflection and reflexivity on both literature and clinical practice, the fundamental intersubjectivity of the psychoanalytic and psychotherapeutic encounter and the Aristotelian concept of phronesis to describe the close interrelationship between theory and practice. To avoid both subjectivism and objectivism, this investigation finds support in the theory of perspectival realism. The dissertation contains an introduction and six scientific papers previously published in both Norwegian and international scientific journals. The first paper describes and discusses the topic of self-disclosure and the active use of the psychotherapist’s subjectivity through for instance an expressive use of the countertransference. The second paper contains a discussion of play observation in clinical assessment of children and how this assessment depends on the investigator’s or psychotherapist’s subjectivity. The third paper is about the relationship between the modern kleinian and relational psychoanalysis, and how they can influence each other on the use of and understanding of the psychoanalyst’s subjectivity. In the fourth paper I try to introduce the concept of “living through” to describe the intense intersubjective situation in intensive treatment of severely disturbed patients. Living through implies that the psychotherapist’s subjectivity gets involved in the treatment process in ways that sometimes are beyond the conscious control of the psychotherapist, and the therapeutic outcome can include a change in both patient and therapist. The fifth paper tries to describe a major example of the psychotherapist’s subjectivity and how it becomes decisive in the treatment process through the therapist’s reverie. The last paper discusses the contribution of modern psychoanalytic and neurobiological perspectives on the understanding of serious mental illness. The psychotherapeutic treatment of psychosis and personality disorders makes great demands on the psychotherapist’s subjectivity. This investigation concludes that it is impossible to keep the psychotherapist’s subjectivity away from the treatment or that it should be minimized. The psychotherapist’s subjectivity is an unavoidable part of the psychotherapeutic process. It is both an important listening instrument and a disturbing factor and source of error. The psychotherapist should not try to take away his or her subjectivity (it’s also impossible), but instead try to relate to, describe, understand, use constructively and try to reduce its eventual harmful effects.