SELF-AWARENESS

The Analyst’s Variable Capacity for Self-Awareness

Richard Tuch

Richard Tuch, M.D., is a training and supervising analyst at the New Center for Psychoanalysis. He has just published Psychoanalytic Method in Motion: Controversies and Evolution of Clinical Theory and Practice, Routledge (2018).

Richard Tuch

Many psychoanalysts believe that the evolution of clinical technique hastened as analysts came to appreciate the extent to which countertransference enactments provide valuable data capable of furthering the treatment—as long as the situation is carefully managed. The fruits of what could be called “the enactment movement” extend beyond the furtherance of technique and include an evolution in how psychoanalysts view their collective capacity for self-awareness. We can further claim that this movement has contributed to our understanding of the process of introspection in a more global sense, particularly regarding the matter of when one comes to consciously know what one implicitly knows on a preconscious basis. As we’re about to see, presence of mind is a prerequisite for reflective thinking.

While one would expect a training analysis to substantially expand an analyst’s capacity for self-reflection, this is only true to an extent; no analyst can consistently maintain an unwavering psychoanalytic perspective. The capacity to be self-reflective is a hard-won and an easily lost ability, and the analyst’s reflective capacity waxes and wanes throughout the day as a function of a variety of factors, some solely related to the analyst and others arising from the rigors of treating certain types of patients—in particular, those who make effective use of projective identification, those who are unusually adept at drawing the analyst into countertransference enactments, and/or those with whom strong affects rule the day.

Consider the eyebrow-raising position taken by Owen Renik (1993) who insisted an analyst’s countertransference awareness is always after the fact:

Everything I know about my own work and that of my colleagues leads me to the conclusion that an analyst’s awareness of his or her emotional responses as they arise in the course of an analysis necessarily follows translation of those responses into action—i.e., awareness of countertransference is always retrospective, preceded by countertransference enactment.

The fact that Renik peppered his argument with such words as “always” and “never” 11 times proved off putting to analysts who not only think in more temperate terms but also recognized an abundance of times when they themselves had been fully aware of their countertransference reactions before they’d gone on to trigger an enactment. While his use of such absolute language greatly weakened his argument, Renik was on to a truism that casts doubt on some analysts’ claims to be as self-aware as they fashion themselves to be. I believe analysts oftentimes recognize such failures of self-awareness or self-reflection only after the fact as they become more completely aware of something about which they had previously been so dimly aware as to stretch the meaning of the term “aware” beyond reason.

A clinical illustration of instances when an individual retrospectively came to realize he or she previously had been subliminally aware of some bit of psychic content appears in Freud’s 1914 writings about the recovery of forgotten memories: “When the patient talks about these ‘forgotten’ things he seldom fails to add: ‘As a matter of fact I’ve always known it; only I’ve never thought of it.’“ This statement confounded me for the longest time until I realized Freud was alluding to the preconscious: that once one becomes fully aware of something about which one previously had been dimly aware, one subsequently realizes that they had, in fact, known such a thing all along—meaning, they had been “kind of” aware, though not aware enough to have been able to declare that they knew such a thing at the time. Psychic content lying on the border of awareness cannot be said to be “known” until such a time as awareness intensifies, leading an individual to retrospectively realize he had known about the matter all along, though not enough at the time to know he knew it; meaning he had been in no position to declare at the time, even to himself, that he knew about the existence of such thoughts, feelings, impulses, and memories. Here, Freud is identifying a truism about human introspection. A corollary to this proposition states: Once this bit of psychic content comes sharply into view—awakening one to the fact that it had always been close at hand if not in hand—one has a harder time reconstructing the experience of having not known it at the time.

What conditions must be met in order to permit the preconscious to become conscious? This question leads to a consideration of what I call “the variable presence-of-mind model,” which posits that an individual often loses presence of mind when immersed in a powerful emotional experience, making it hard—if not impossible—for him to think reflectively about the situation as one would be able to do if at a distance from the experience. I first described this phenomenon as it manifests in the behavior of women who had been exposed to genital exhibitionism, which typically leads to a loss of presence of mind that is needed to marshal an adequate ego response, which most victims could have mounted save for the fact that the nature of the traumatic experience—the literally mind-boggling incongruity of being confronted with such unexpected behavior—had effectively rendered them “frozen, immobile, rooted to the spot’“ (Alfred Siegman, 1964) When one considers the experience of being exposed to exhibitionism from the comfortable position of merely imagining such an event rather than actually finding oneself in such a literally compromising position, it can prove difficult to imagine becoming so completely, psychically indisposed, even though that is precisely what most victims report—sometimes a bit ashamed for having lost their capacity to act in a self-protective manner.

Sometimes such compromising conditions arise in the clinical setting, particularly when the analyst is under the sway of projective identification or swept up on an enactment yet blind to the fact. Ronald Britton (1989) describes his treatment of a difficult patient who made it extremely hard for him to think in her presence.

It seemed impossible to disentangle myself sufficiently from the to-and-fro of the interaction to know what was going on… What I felt I needed desperately was a place in my mind that I could step into sideways from which I could look at things. If I tried to force myself into such a position by asserting a description of her in analytic terms, she would become violent, sometimes physically, sometimes by screaming.

It is humbling for analysts to have to admit their capacity to remain consistently and sufficiently self-reflective is more variable than they imagine it to be—and believe it needs to be. Such a realization relieves analysts of the heavy burden previously created by portrayals of an analyst’s ability to, more or less, remain sufficiently self-aware with rare exception—a portrayal that runs counter to what most analysts privately recognized as their more limited ability—their failure to be able to live up to a supposedly achievable ideal. While being psychoanalyzed likely heightens one’s overall level of conscious awareness, one’s moment-to-moment ability to be self-reflective proves to be highly variable and fretting about the matter or feeling ashamed that such are the conditions under which we work is unhelpful at best, and can burden one’s ability to do the work. Faulting oneself for having “known” all along something that one only now recognizes to be, is dangerous given that such thinking is predicated on a misunderstanding of the nuances of the introspective process. Being realistic about our own psychic processes is needed for us to be in a position to present to our patients a realistic and humbling picture of the human limitations of perception.