Who is Talking in Talk-Therapy?
I recently met with a new patient-intake, a bright young man who has lost his will to live, has no desire, has become apathetic to the point where he no longer bathes. I told him, per my school’s maxim, that the goal of therapy was to say everything. “You want me to say everything,” he said, “like, only I talk?”
This may have been a clinical error on my part, but one that my school told me to do. Say everything is the principal maxim of Modern Psychoanalysis. My own analyst has told me to say everything many times, stating it both as goal and command. While I believed in this imperative at one point, now that I am seeing patients, I am much less certain. It has dawned on me that the command say everything, aside from being slightly ridiculous (is it even possible to say everything?), is also a rather daunting entry point to the treatment; as if I had placed before the patient a large and forbidding mountain, and asked him to climb it.
It is true that in psychoanalytic treatment the patient does the great majority of the talking. This has produced a stereotype of the silent psychoanalyst, dispassionately observing the suffering patient. The command say everything doubles as implicit relational context: if the patient is saying everything, when does the therapist speak? Two patient-intakes in succession have told me that they want a therapist that talks to them. Whatever could have given them the idea of the therapist who does not talk? While silent presence is a powerful tool, and the therapeutic dialogue is not a conversation by any conventional standards, the psychoanalyst does indeed talk, but they speak only from inside the patient’s world.
Freud did not ask his patients to say everything, but rather to say a particular kind of thing, to speak whatever was on their mind, no matter how absurd or shameful. This is the famous free association, an ecstatic technique that, for Freud, makes the fundamental rule of psychoanalysis. It is a rule that the Moderns have abandoned and even discourage (at least my supervisor does). The moderns argue that certain regressed or preverbal patients are incapable of freely associating and, treating every patient that comes in the door as if they were schizophrenic, they ignore the fundamental rule as a curtesy to the patient. Instead they say “say everything;” like it really does not matter what you’re talking about as long as you’re talking. In the long arc of saying everything, which takes like thirty years, the patient will eventually begin to translate primordial feelings into speech; this is known by the technical term progressive communication. The Europeans joke that American psychoanalysts have perfected the interminable analysis in the interests of job security; the Moderns are exemplary with their endless waiting for everything to be said.
While a gifted analyst may be able to intuit repressed material from a patient endlessly recapping episodes of Friends, or recalling what happened in baseball that week, most analysts would be rightly bored. Here we can find a helpful distinction, borrowed from Lacan, of full speech and empty speech. Empty speech is ego-speech: what you ate for lunch that day, or talking about the weather. Full speech bares some relation to desire, like talking about how much you hate your mother, or your inability to get out of bed in the morning. The moderns’ idea of progressive communication implies that while the patient may begin with empty chatter. they will eventually ascend to a potent speech of pure rage (the Moderns have replaced desire with aggression).
The value of freely associating, as I see it, is that it can make a direct path to full speech. A way to evade the censor, it’s like doing a Freudian slip on purpose. If the ego is a loop, a well-trodden path of habitual niceties where patients tend to repeat themselves, to say the same thing over and over again, then freely associating is ecstatic in as much as this loop is discontinued, turned into a loop de loop, or totally sprung into who knows what. It’s an altered state induced by the current of drive energies. It is no longer the I that is doing the talking.
What animates desire (or aggression) remains unrepresentable, and yet the automatic-speech of the patient lying supine upon the couch may imaginatively express this desire. This can lead to what Freud called “helpful ideas;” (hilfsvorstellungen) something rather more than merely transposing feelings into language, an act of making something new and unexpected. With the metaphor of the mountain in mind, we might say that instead of the indefinite slog of climbing upwards in the attempt to say everything, free association can open up a cave in the mountain side—like the goblin cave that opens in The Hobbit—and who knows what kind of magic lies that way.
Does this mean that the large amounts of time it takes to say everything can be condensed into vertices of mind-altering speech-acts…?
Mount Robeson, British Columbia, Canada, 2012, photo by author
