When the patient comes, I say: “I know it is not easy to start talking about oneself to a stranger, but what can you tell me that would be helpful for me to understand you?” I see how they begin and I notice the content, but I also pay attention to the defense mechanisms, the avoidances, to what they don’t want to talk about. I let them know that it is important to say everything that occurs to them. “Free association” is really our basic tool . . . it yields insights that the patient does not censor.
So after I come to some conclusion, I say: “From what you tell me, I understand the following . . .” Then, I judge their capacity for insight. With some people, you can go deeper faster; with others, it is extremely delicate. You learn whether you have to watch your words very carefully, depending on how suspicious, disturbed, or trustful the patient is.
So you gradually create within yourself an image of the person and then you communicate out of your image. As you get to know the patient, the image becomes more articulate. In all of this, I am not focused on change. I am trying to understand what the patient is about and allowing him or her to develop the goal of his or her own changing.
I also use metaphors. Let’s say a patient is upset that he is not making any progress, then I might tell the following story. “Two men meet in Tel Aviv, and their conversation goes like this: ‘I haven’t seen you in a while!’ ‘Of course not, I was in South Africa.’ ‘What were you doing there?’ ‘I was on a safari.’ ‘The whole year?’ ‘Yes, the whole year. I was hunting lions.’ ‘How many lions did you get?’ ‘How many did I get? None!’” When it comes to lions, none is quite a bit!
I tell this vignette when a patient complains. It conveys the idea that some goals are difficult to attain. Like Alice in Wonderland, it takes all the running you can do, just to stay in the same place. That would be a similar idea.
I have been an analyst for 50 years, and if there is anything that I still find astonishing, it is that every patient has something new to communicate. Some have so much new to say that it’s bewildering.
It is as if an analyst is not only living his own life but also the lives of countless other people. So I think I am making a bargain with death. I am cheating. I am living more than one life.