Telling Stories : Narratives in Psychodynamic Psychotherapy

The psychotherapist’s office is a place, at its best, where people tell their most private stories to have their stories reflected back accurately with new and useful insight.

Psychotherapists watch for 1) any communication that gives them a new or deeper appreciation for the patient’s unique world and for 2) ways that each person unconsciously communicates through symbolic language (stories, memories, actions, gestures, etc.) the emotional and influential features of their inner world. The therapist must communicate his or her understanding with empathy and clarity at a useful moment. The therapeutic attention to unconscious symbolic communication is what identifies psychoanalytic psychotherapy of various persuasions as psychodynamic.

When analysis works at its best, each session begins with three radical assumptions: 1) Each person has a story, 2) their story makes sense, even though it may elude us, and 3) this story is worth listening to carefully without prejudice. Each session of analysis or therapy for the past 100+ years has asserted that we all have a unique, compelling, and coherent story. This is revolutionary. Not so long ago, only gods, goddesses, kings, queens, and heroes had stories worth telling. The rest didn't have a voice. Not so long ago, we incarcerated the "mentally ill"--they didn't have intelligible, perceptive, challenging emotional stories. We silenced the victims of abuse, rape, poverty, and sexual or racial discrimination--we didn't want to hear their stories. It was even hard to listen attentively to the stories of children; for many people, it is still hard.

A century of psychoanalysis and psychotherapy taught us how to listen respectfully to ourselves and to each other. Listening respectfully--to dreams, to internal dialogues, to other people, to feelings and fantasies--is the hardest thing that psychotherapists and patients do. As analysts and therapists listen, they and their clients collaborate on the interpretation of personal histories and the telling of new stories. Together they take apart, analyze, and rewrite the old stories of childhood and the family, of love and work. They come up with new interpretations, amended histories, revised maps, and epiphanies. In any therapy worth its salt, the therapist grows along with the patient. Each educates the other.

Psychoanalysis and psychotherapy are not practiced in a vacuum. The words and stories that pass back and forth session after session eventually move into the larger world and touch us all. Therapists and patients act on the new stories that stir them, and they pass on new truths to loved ones, colleagues, or strangers on the street. You don't have to enter therapy today to know the value of remembering, talking, and listening. You can live without reading Freud or Jung but because of this psychological century you may enter a relationship knowing how to distinguish your baggage from another’s, still ask questions rather than define the other, still talk about your feelings. Without therapy we wouldn't have learned to be so interested in nuances of feeling or the intricacies of anxiety and depression.

The stories of therapy create new truths of the human heart, new, first-time feelings and ideas. Consider for a moment one important way in which psychotherapy changed us and changed the lives of our children. Because of therapy, we understand the effects of child abuse as never before. Psychotherapists, however, didn't just discover child abuse--they enabled us to feel the abuse and know it for the first time.(1) We recognize the numbness and dissociation that occur in the presence of someone intoxicated and threatening. When we say, "This is child abuse," we identify familiar feelings and ethical or legal responsibilities that didn't exist fifty years or five hundred years ago.

Therapists and clients talked about abuse, thought about it, found the words for it, wove stories, generated new feelings, and created new values. I don't think that child abuse was fully experienced or known as abuse until we found the words to say it. Two hundred years ago, John Wesley could sincerely say, "Break the will if you would not damn the child . . . .. Let a child from a year old be taught to fear the rod and cry softly." Wesley’s Methodist congregation revered him for these words.(2) Today we call this child abuse and we are far more likely to contact Child Protective Services. Today we tell different stories of childhood and the family, and as a result, our feelings about children and the family are new feelings. The stories we tell back and forth educate our hearts.

When we tell our stories, we want to create a vivid and continuous dream in the listener's heart and mind. As John Gardner says, this dream is the aim of all fiction, all stories. (3) As an analyst, therefore, I look for the language, details, memories, events, and metaphors that make the patient’s story precise and vivid. I watch for the distractions, defenses, and narrative flaws that break the continuity of the dream. We all, as I said earlier, have a unique, compelling, and coherent story to tell. When psychotherapy works, the patient can tell her or his story with narrative competence and create a powerful, vivid, and continuous dream in the analyst's mind, a memorable dream.

First, we create our lives and the world with the stories we hear and tell. In other words, we maintain our world primarily in conversation--inner dialogues, face to face conversations, and a vast series of conversations we carry on through books, newspapers, films, magazines, televised stories, e-mail, weblogs, photo albums, and paintings worth a thousand words. Dreaming does not stop.

The second premise is this: Psychoanalysis is a revolutionary form of conversation, the first to consistently respect any private story we dare or feel compelled to tell. Psychoanalytic talking and listening occur at appointed, ritualized times and places, with exacting linguistic conventions, ethical codes, aesthetic guidelines, and scientific standards. I suspect that we have only explored a fraction of the potential in this extraordinary form of conversation.

Thirdly, the stories therapists and patients tell affect each other’s heart and mind. Each insight achieved educates each other's heart. And, as I have tried to argue, good stories find their way from the consulting room to friends, families, strangers, and if these stories are vital enough, they find their way into the public domain.

Since millions of people talk to therapists, the cultural effects of psychotherapy are more profound now than they were in the heyday of psychoanalysis. Imagine the numbers of people who have said to their partners, "I want you to listen to me the way my therapist listens to me," or "I want to know how you feel." People didn't say those things fifty or a hundred years ago. The intimacy people desire today is not the intimacy that earlier generations practiced or imagined. When millions of people sit in closed, quiet rooms and talk about their lives, they gradually change the psychological fabric of the world for all of us.

As all analysts know, the more we talk, the more we discover. And because millions of people have talked to analysts of one persuasion or another about their memories of childhood, we now think and feel differently about childhood. After several decades of analysis, many of us now see children as young, bright-eyed explorers in love with the world. We no longer think of children as blank slates, willful menaces, future servants, or the sexual denizens they were once thought to be. Psychoanalysis changed and continues to change our convictions and our experiences of children, childhood, parents, and parenting. Future adults will be different adults.(4) This is a realistic hope just as we realistically enter psychotherapy desiring change.

References
1. Freud discovered the psychological effects of sexual abuse but then disavowed his discovery. For a discussion of the history of Freud's incest theory, see Janet Malcolm, In the Freud Archives (New York: Alfred A. Knopf, 1984). 2. Anthony Synnott, "Little Angels, Little Devils," in Child Development Today and Tomorrow, ed. William Damon (San Francisco: Jossey-Bass Publishers, 1989), p. 28. 3. John Gardner, The Art of Fiction (New York: Alfred A. Knopf, 1984), p. 31. 4. Compare Daniel N. Stern, The Interpersonal World of the Infant (New York: Basic Books, Inc., 1985), pp. 276-277. "If seeing the infant as different begins to make the children, adolescents, and adults different enough a generation later, then we will be seeing different patients at that point-- patients who will have experienced a somewhat different infancy and whose interpersonal worlds have developed slightly differently. The therapeutic encounter with this new patient will again require changes in clinical theory and search strategies. Just as infants must develop, so must our theories about what they experience and who they are." These line conclude the Epilogue to Stern's important work.