Some Thoughts on Interpretation
As I mentioned in a previous post, I’ve recently been working through Horacio Etchegoyen’s Fundamentals of Psychoanalytic Technique. This project has largely been driven by an understanding I was given of the content of that text, to which I will say that, thus far, it has held up. The book is largely concerned with tracing the development of the concepts of transference and interpretation, two of the most compellingly nuanced and sophisticated processes involved in the task of doing psychotherapeutic work. And yet, for all their complexity, what the two concepts are really all about is an attempt to answer two very basic questions: “How should we listen?” and “How should we respond?”
Given the quality of activity involved in the analysis and use of both these principles, it is my belief that they must be practiced via experience for one to become any more skilled at them. As much as reading a text like Etchegoyen’s can help establish a foundation for the kind of things one might think about in reflecting on these concepts, they are—in essence—concepts which must be felt into to be done well. Which, to say it another way, must be experienced in the context of different relationships, over and again, to really be, in any substantial way, known.
I will be more focused on the concept of interpretation here, but we really cannot conceive of one without the other. Responding and listening are intimately linked, with responses being both a reflection of what we are listening to, as well as shaping what we might be able to hear. Both “good” and “bad” interpretations drive the therapeutic process in ways that are utterly unpredictable, complicating the process of what it really is to listen and respond. It’s hard to translate the true circularity of this process into writing. Both processes are part of a perpetually unfolding interactional matrix of discourse and communication, where meaning remains in a state of permanent flux. This kind of resistance to stagnation can be both a gift and a curse. On the one hand, it means the ability to really feel one’s way into what is happening relationally within a therapeutic dyad takes time and will almost definitely involve a series of missteps along the way. However, the kind of vitality we are considering here means that no interpretation is final and that, via the kind of repetitions that analysis and philosophy are so fond of exploring, moments will inevitably cycle back through for us to offer something either slightly or considerably modified the next time around.
The thing I am thinking about with interpretation lately is still not terribly well worked out for me conceptually. Nonetheless, I thought it could be helpful to start writing about it anyway to begin to refine my understanding of what it is I am talking about and beginning to see in the work that I do. It is something that has come up in my own supervision and has even found some analogues in various conversations I have been having with clients about their own experience of relating to others. In addition to my own training and the above mentioned Etchegoyen book, this approach is largely informed by an earlier reading of Therapeutic Modes of Action by Martha Stark, another remarkable text that I found incredibly foundational to my own work and yet is little discussed.
In the context of this discussion, I want to examine the possibility of interpretation along a self-other continuum of possible orientations, with a kind of organizational hierarchy being something like: other interpretations (assessment or feedback), self interpretations (revelation or disclosure), self-other interpretations (relational or intersubjective communication). Anyone who has read Stark’s work might already be seeing a parallel to her version of the one, one-and-a-half, and two-person modes of action.
Other interpretations, or what I would call assessment or feedback, are one-directional (and often one-dimensional) reflections by the therapist about something that is exclusively contained within the client. Every therapy is guilty of this to some extent, and this type of feedback is not entirely without merit. This is the kind of feedback that might be involved in someone detailing things like cognitive distortions, identifying unconscious or psychodynamic processes, labeling unwanted behavioral tendencies, etc. Some of this can be foundational in developing insight in the client and starting to cultivate what is sometimes referred to as the ability to be “psychologically minded”. With some clients, we need to begin by driving home a sense that these facets of their life are worthy of inquiry or examination. That much of what they take for granted about many of their interactions with the world and its objects can be experienced through both a subjective and objective lens. I think this can also be a great way, when done sensitively, of beginning to cultivate a strong therapeutic rapport with a client, revealing a sense of empathy, a desire to see and understand the client, and building a shared language around some of the ideas and concerns that the client is bringing into the relationship.
The next position is that of self interpretations, otherwise known as revelation or therapeutic self-disclosure. The kind of disclosure or revealing we are discussing here is not the kind of general self-disclosure that comes within the frame of any therapeutic process: the subtle ways we let clients know about our own process or things about who we are or where we are coming from that might consciously or unconsciously seep into the therapeutic relationship over time. I am specifically here thinking about here-and-now interpretations that center on something that is happening within the therapist as a result of some aspect of the therapeutic work. Again, this kind of interpretation can be a step towards some kind of awakening or awareness for the client. A therapist’s ability to bring in their own immediate emotional responses can be instrumental in helping a client identify or access their own store of emotions around something they are sharing. Being able to say to someone “Mmm, I feel a kind of anger coming up in me right now” or “There is a sense of sadness about this…do you feel that too?” has the power to give them something related to naming and experiencing their emotions that may have been developmentally bypassed. A process which can be incredibly transformative for some patients. Stark points out that here the therapist is a “half-person” as it is less about the authentic, here-and-now relationship with the therapist, but is about the provision of some corrective experience as a loving self-object or good-object that provides the conditions for therapeutic growth.
The self-other relational or intersubjective interpretation is the mode of interpreting that takes the most conditioning to understand and do effectively. This is not to say it is the most important, as all these interpretative styles can be necessary at times and are effective each in their own way. However, relational interpretations are in their construction a bit more nuanced and can be transformative in helping someone really get to the core of and potentially shift their interpersonal impact in ways that the other two modes simply cannot quite achieve.
The relational mode usually relies on a basic ability to read projective identification type transference/countertransference phenomena in the session, as well as the therapist’s ability to understand their own emotional, unconscious, and transferential tendencies. The reason for the latter is that this type of interpretation means providing the client with some feedback about the therapists perception of what is happening between the client and therapist, which requires the therapist being able to discern to some degree what is “really” there versus what is their own “stuff” (and is one of the factors that lends itself to the idea that good therapy requires the therapist having or having had their own therapy/analysis and good supervision). Stark offers a couple of versions of this (her two-person interpretation) in the text, examining what it might be like to respond to a client who often presses for reassurance by saying something like “In the experiences we are sharing, I think I am beginning to understand something of what it was like for you to constantly feel the need to reassure your mother in order to bolster her self-esteem.” One can imagine even identifying responses that take this response out of the realm of projective identification and into the here-and-now of the actual relationship with something more like, “I’m noticing in me a strong sense of feeling an appeal for some kind of reassurance. Can you feel that? What do you make of that?” And then later “I’m wondering what it’s like for you in these moments when you don’t get that?”
These are certainly the types of interventions that an existential-analytic approach to therapy is going to be most captivated by. The other types of interventions are largely about meaning-making and a kind of world-building for the client. These interpretations bring the world and the therapy into direct contact, hopefully moving the client deeper into their lived experience and giving them some increased impression of their capacity to move into that space via the containing function of the relationship. It is through this process that we can elicit what is already present for the client, their implicit ability to already bear what it is they feel needs changing via feeling into the dialectical tensions and paradoxes that define all modes of existence.
Freud landed on this point in the very begin, noting in his first published works that the psychoanalysis he was developing served the process of helping neurotic misery find its way into “ordinary unhappiness”. By thoughtfully blending and feeling our way into these self-other configurations of interpretation, through the complex shifts in the organizing structures of the therapeutic relationship, we can artfully evoke a subtle living-into that is unique to the process of well-executed therapy and offer the client some of the truly unique gifts that this discipline affords.
