Shirah Vollmer MD

The Musings of Dr. Vollmer

Psychoanalytic Tact

Posted by Dr. Vollmer on October 9, 2012

William Sledge MD, pioneered a concept of “psychoanalytic tact.” “Tact refers to touching (and the sense of touch) and a sense of what is proper and fitting,” he says in his 1989 paper entitled “The Psychoanalytic Use of Tact,” published in the Psychoanalytic Study of the Child. This is a brilliant paper which outlines that great ideas, or understanding of patients, are only helpful, if they can be delivered in a way in which the patient can receive the idea, without feeling so much shame and humiliation that they flee from the treatment experience. Pulling on Freud’s topographical model of the mind, in which one goes from surface to depth of mental structure, Sledge agrees that part of tact is understanding the patient’s level of understanding of his own psychic structure. The adage “know your audience” applies here, but in this case, it is “know the level of your patient’s understanding of himself.” Like so many finely developed skills, it sounds so much simpler than it is. So, begins my new psychoanalytic course on “The Technique of Psychoanalysis”. This course translates theory into practice in a way which highlights the uncertainties in the field, and the art of psychoanalysis. Exactly how do you tell a patient they have sadistic impulses, is the question that often arises. “We introduce our patients to themselves,” I say, attempting humor, but also hoping to convey the gift of understanding, even at the expense of a perceived body blow. One of Dr. Sledge’s main point is what Anna Freud termed neutrality, which the lay public would term “nonjudgmental” listening. Anna Freud spoke about how an analyst must remain in a mid-point between ego, id and superego. We neither admonish or give permission. For example, a married patient who fantasizes about having an affair, would be “heard” as one who is struggling between his id, his drive for immediate satisfaction, versus his superego which tells him that it is wrong to betray his wife. The therapist helps the patient articulate this dilemma, rather than recoiling at the idea of an affair, or nonverbally supporting the affair as a way to enable the therapist to live vicariously. This “neutrality” raises one of the many delicate issues in psychoanalytic treatment. It also creates wonderful material for a class discussion. Like in psychotherapy, tact is critical in my teaching activities. It is hard to teach without shaming. To explain a new idea has the potential to make my students feel unskilled and inadequate in the profession. Illuminating theory and practice also offers students an opportunity to see their professional endeavors in a novel and exciting way. As a teacher, I have experienced the highs and lows of this narrow path. My new class presents me with new challenges to use psychoanalytic tact. Thank you, Dr. Sledge.

2 Responses to “Psychoanalytic Tact”

  1. Shelly said

    What a fascinating piece. When you say that it is “hard to teach without shaming,” do you mean that it is hard to teach your students because you place moral judgments on your patients’ actions and perhaps some of your students may be guilty of doing the same? In your therapy sessions, is it not difficult to remain completely neutral when not only your words must remain noncritical, but nonverbals such as tone, timing of your words, body language and facial expressions also convey meaning? I was once told that only in individual therapy are therapists supposed to be non-judgmental; and that in parental instruction and marriage counseling one can be biased. Is that the case?

    • Thanks. It is hard to teach students because they place moral judgments on themselves, which I might be challenging unwittingly. Yes, neutrality is a very difficult experience, because, as you say, there are both verbal and nonverbal cues. Parent training and marital therapy involve more direction, which can involve more “judgment” but this is meant to express expertise, rather than values. Of course, the lines are not so clear. Thanks, as always.

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