Fine-Thomas Psychotherapy

Albert Einstein is thought to have said, "The intuitive mind is a sacred gift and the rational mind is a faithful servant. We have created a society that honors the servant and has forgotten the gift." He seems to have captured the spirit of the therapeutic attitude to remind us that we would do well to honor our intuition.

There is yet more to this second layer of the therapeutic attitude. Psychoanalysis points to a particular process that occurs between therapist and patient that neither is exactly aware of.
I liken the ability to have access to the phenomena of unconscious process to being aware of one’s heart rate. We all understand that every day our heart beats about 100,000 times. It is always working. For most people, most of the time, we give little thought to this fact. It occurs in the background while we go about our day. And, often when we do notice our heart rate, it is because something seems to be wrong: it is either beating unusually fast, arhythmically, or too slow. Otherwise, we don’t really think of it. However, it is possible to change your heart rate by paying close attention to it. By slowing your breathing or taking your pulse, you can make yourself aware of your heart rate and thus work toward slowing it. But, you can only do this for a limited amount of time before the realities of life call your attention back to other things. Those who cultivate this skill through activities like meditation can lengthen the amount of time they become aware of their heart rate. Focusing your attention in this way is akin to being aware of unconscious processes happening inside and between our patients and us. The therapeutic attitude is analogous to meditation in that it requires a kind of focus on something that is normally not in our awareness and that would naturally not be something we pay attention to. It takes a special kind of effort to stay focused on this attitude.

The second layer of the analytic attitude is more nuanced and complex. From the beginning, psychoanalysis has made efforts to describe how people know when we feign openness, curiosity, or anything else. One clinician might ask the same questions of a patient as another but receive different answers partly because the patient is trying to perceive the intentions and attitude of the therapist. In a well known vignette, Greenson (The Technique and Practice of Psychoanalysis, 1967) describes an encounter with a patient who discerned that Greenson was a Democrat despite Greenson never commenting on his political affiliation. The patient, over time, realized that when he commented on the Republican candidate, Greenson would ask for associations but not when he commented on the Democrat. Likewise, when he criticized the Democrat, Greenson would ask who the Democrat reminded him of. Greenson had no awareness of treating the patient differently based on what he said related to the political affiliation. He was surprised to learn that his patient knew something true about him that he had never consciously disclosed.