Patient Sculpting

 

Hans Loewald  discusses the idea of patient sculpting, meaning that the therapist imagines the patient without his neurosis, and in so doing, imagines the patient having a more fulfilling life. What would the patient be like if he did not live out the guilt of his parents, for example. Lewis, sixty-six comes to mind. He is the son of holocaust survivors. Parents who instilled in him a sense that the world is a frightening place and he must be suspicious at all times. Lewis has embraced this philosophy unwittingly, living his life in constant fear, but not exactly understanding what he is afraid of. Imagining Lewis without anxiety is what some theoreticians call an “analytic stance”. If Lewis could come to understand that he “inherited” this fear from the trauma his parents experienced, then he could begin to separate out his reality from theirs. In so doing, Lewis could come to experience life in a more relaxed and engaging manner. Moreover, his physical symptoms of irritable bowel and intermittent headaches might improve substantially. A patient without anxiety uncovers the goodness of his soul, as anxiety can obscure that. Keeping the vision provides hope for patients. All of this is not spoken, and yet, magically transmitted between therapist and patient. How to teach these concepts is challenging and yet also very fulfilling. As with sculpture, each student has to find his method. The art of psychotherapy lies in its creativity and in its uniqueness with each therapist/patient dyad. There, I have said it again.

 

https://en.wikipedia.org/wiki/Hans_Loewald

Why Is It Hard To Stay Curious?

 

The therapist, as Hans Loewald says, holds in mind an image of the patient without neurotic distortions. In other words, the therapist can see how the patient mis-perceives his universe, and in so doing, causes himself to suffer, and so it stands to reason that if perceptions could be more accurate, or less historical, then the patient would suffer a lot less. In other words, we, as humans, unconsciously feel that current situations are triggering past situations, and so we react as we did in the past, without the benefit of a more mature mind. The therapist, mindful of this distortion, envisions the patient with a more mature mind, and thereby imagines a patient with a more fulfilling life. This imagination creates therapeutic zeal, which in the right amount, can carry the therapist and the patient through hard therapeutic times, but if the therapeutic zeal tilts to a more self-centered approach by the therapist than that zeal can kill the treatment. This brings me to my class tomorrow. We will discuss how to imagine patients without symptoms, without being overbearing or inserting one’s own agenda. The sweet spot of curiosity without a specific agenda is the gift we give to our patients. Yet, it is hard to stay curious. Maybe we didn’t sleep well. Maybe we are burnt out. Maybe the patient is boring. Maybe we have too many acute issues on our plate and there is not enough bandwidth to think about someone else’s problems. Maybe we are  hungry. My class is designed to talk about ways in which we mess ourselves up, and by we I mean we therapists. That perhaps building a psychoanalytic practice, or a psychotherapy practice is not what we want to be doing. Can we express that out loud? Maybe we have serious ambivalence. Here, we as therapists, believe that talking about ambivalence is the key to bringing authenticity and depth to one’s inner life, and yet, at the same time, we feel shame in talking about our own ambivalence towards the profession. This ambivalence changes every moment, with every patient, and with the maturing practice and yet, how do we talk about that without feeling shame and without worrying about getting referrals. Do we pretend to always be curious, when, in fact, there are times when we lose our curiosity, when we just want to go home or we just do not want to get out of bed? If authenticity is our holy grail, then we need to be authentic with ourselves, and our trusted colleagues. We have to hold in mind ourselves, with the humanity to know that we do not always show up for patients in the way that we might hope we do. Despite many hours of training, and despite many hours of reading theory, and despite our own treatment, we fail patients, or we are less than optimum, at times. Psychoanalytic work helps us with the concept of repair. We try to repair, knowing that we are flawed. That repair can be a healing process does not justify the fact that we let people down, in subtle ways, in every hour, and with every patient. This is a field of humility. I like to say. We know we do not know what we are doing, and yet, we are motivated to keep trying to do things better and better. We are motivated to stay curious, and then to be curious as to why we lose curiosity. That’s what we do, and for that, patients are helped through the human suffering that brought them to our offices. Or, I should say, we hope for that.