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An Appeal for Cognitive Dissonance

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In my recent blog on The Huffington Post entitled "Finding the Story as Therapist and Writer," I presented a brief clinical vignette describing how my work as a therapist/analyst mimics the way I approach my work as a writer of personal essays. Here is a brief excerpt:

As a therapist, how do I help a patient deepen the story? I do this first by listening. I can't be formulaic. When I hear a patient's history and then leap to think, "Oh, yes, clearly this explains that... or... that," I am robbing the individual and the treatment of all its richness, complexity and maybe even its truth. While of course theory informs my thinking, once in the consulting room I need to put aside these theories and instead, invite my patients' curiosity and their own exploration of their inner landscape, searching for ways to connect more deeply with their experience -- not prematurely imposing my view of the terrain.

Change can only happen if both my patient and I alike are open to the unplanned and unpredictable moment, allowing ourselves to wind up in places we never expected when we began the journey. And like a good story, relishing the many twists and turns along the way.

One unexpected pleasure of posting these blogs has been the many interesting email comments from readers and colleagues. The juxtaposition of four particular emails intrigued me. The first commenter wrote, "Excellent Bionian interventions," another said, "Perfect example of Ego Psychology technique," a third remarked on how well this vignette "illustrates a crucial idea of Lacan," and the fourth noted "a beautiful demonstration of relational work." Ironically, a piece that stressed the importance of approaching material with open eyes and not being wedded to theory generated four distinct theoretical views of the same material. Could they all be right? Yes and no.

Each of these clinicians found themselves and their preferred model of working in the words that they read -- as, of course, we all do. How powerfully and naturally our mind seeks to superimpose theory on to case material, our theoretical expectations shaping what we hear from our patients.

While these were only brief comments -- and of course there are multiple truths one could unravel in any clinical material -- their notes brought to mind the familiar parable of the blind man and the elephant: no matter how true or accurate one's subjective experience may be, our experiences are inherently limited by the lens we use. Like the proverbial blind man, as analysts we all have templates for reading and listening clinical cases. Instead of letting the theory bubble up from the material, over time, we tend to wrap theory around the material. Of course I am not advocating an empty mind, but one open to possibilities -- in both our self and our patient.

Keats writing to his brothers (December 22, 1817), puts forth the idea that a poet needs to remain receptive, never reaching any final answers or certainties, no matter how unbearable. "I mean Negative Capability, that is when man is capable of being in uncertainties, mysteries, doubts, without any irritable reaching after fact and reason..."

He is extolling an artist's receptiveness to the world -- to its beauty -- to think beyond our presumptions, to live in uncertainty and to not reach "after fact and reason." In a later letter he wrote, "The only means of strengthening one's intellect is to make up one's mind about nothing -- to let the mind be a thoroughfare for all thoughts. Not a select party."

In essence Keats is urging us to be creative, remaining open to what we see in the world, to encompass all the possibilities -- and certainly exploring the unconscious mind requires creativity. In the consulting room and in listening to our colleagues' work, maybe we too, can think more like the poet. Real change can only happen between our patients and ourselves if we are willing to be surprised, to value different viewpoints, accept the limits of our open-mindedness, question our theoretical certainties, pose questions from a different vantage point and at times disregard convention.

Keats, J. (2002). John Keats Selected Letters. Letter to George and Thomas Keats December 22, 1817 (pp. 41-42). New York: Oxford University Press.