The Psychotherapeutic Stance by Carsten René Jørgensen

Author:Carsten René Jørgensen
Language: eng
Format: epub, pdf
ISBN: 9783030204372
Publisher: Springer International Publishing

9.2 Evenly Suspended Attention

Freud describes that the therapist should meet the patient with ‘evenly suspended attention’, which ‘consists simply in not directing one’s notice to anything in particular and in maintaining the same “evenly-suspended attention”’ (Freud 1958b[1912]:111). The therapist ‘should simply listen, and not bother about whether he is keeping anything in mind’ (Freud 1958b[1912]:112). The ‘most successful cases are those in which one proceeds, as it were, without any purpose in view, allows oneself to be taken by surprise by any new turn in them, and always meets them with an open mind, free from any presuppositions’ (Freud 1958b[1912]:114). In practice, this means that the therapist should remain as open as possible to what the patient consciously and unconsciously communicates in the therapeutic space, that he should (at times) simply go with the flow of the therapeutic and interpersonal process, and remain open to his own ideas, mental states and reactions in the interaction with the patient. Especially at the beginning of each session, it is often a good idea to allow oneself to be carried by the process that emerges, more or less spontaneously, in the therapeutic space; to let the patient’s statements and acts—and what is initiated in the therapeutic relationship—unfold in order to develop a sense of ‘where the patient is at’, and what the patient is most focused on in the moment, on a conscious as well as an unconscious plane. Next, the therapist should be ready to alternate between structuring and focusing the conversation versus going with the flow of the therapeutic process, also referred to as the therapist’s temporary regression in the service of the ego.

According to Freud, the therapist should hold back, resisting the urge to settle too quickly on what is the most important aspect and what to focus on in what the patient says and acts out in the therapeutic space; that requires patience and inner calm from the therapist as well as an ability to tolerate uncertainty. As much as possible, he should liberate himself from external and internal pressures that require him to act quickly in order to make a difference, give the patient something specific (in the form of goal-oriented interventions) and take control. This involves abandoning any illusions of omnipotence without, on the other hand, abandoning one’s responsibility completely, thinking that ‘anything goes’. He should also be able to tolerate the uncertainty of being in a situation where he does not immediately understand or know what to do, giving up any notion that the best way to help the patient is via targeted actions (showing agency, taking charge and so on). In order to help another human being one must first uncover ‘what the issue is’, the core of the other’s difficulties, which takes patience, inner calm, empathy and the ability to listen. Only then can he offer a qualified opinion as to what can be done to help. In some cases, the most important and helpful approach is in fact to listen, take the necessary

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