The Longing

Psychotherapy Based on Human Longing.

Murphy, Robert C. (1970)
Wallingford, Penn.: Pendle Hill Pamphlets (No. 3)

Dear friend, I offer this copy of a cherished booklet by Robert Murphy. It was first published in 1965 - before the era of attempts to create an English which does not "he/him" for woman as well as man. Please don't let the "man's existence", "his", and all those male oriented constructions, obscure it's call. Other critiques are useful, such as thinking more about power issues in any process e.g. where one person is "paid to listen". There's something special in it for me but as soon as "I" turn that into an expectation of "my self" or an "other" I've lost it. Discussions welcome. Graham Bird, CLI, October 04

About the author / ROBERT C. MURPHY, JR., was educated at Harvard College and Cornell University Medical College. Returning from service after the war, he was trained at the Menninger Foundation School of Psychiatry, and studied also at the Topeka Institute for Psychoanalysis. For the past twelve years he has divided his time between community psychiatry, private practice, and teaching. He has written previously for a number of medical and psychiatric journals, and for the Nation. He is married, and has three children. Robert Murphy has recently been appointed a member of the Pendle Hill Board.

Copied from the out of print pamphlet: PENDLE HILL PAMPHLET 111
Library of Congress catalog number 60-14173
Printed in the United States of America by Sowers Printing Company, Lebanon, Pennsylvania, August 1970 / 1,500 copies (4th printing)

Buried in the deepest stratum of his unconscious, at the wellspring of man's existence, lies an immense psychological force. In pure form, it is experienced as a longing, the object of which is constantly receding from him, as the horizons of his world widen throughout his growth. It begins, perhaps, with the infant's amazing discovery that the breast which brings it comfort is not a part of itself, but actually belongs to another, sentient, being. From that moment longing drives the human organism to relate himself to, to comprehend, in the deepest sense to "love," that which lies beyond him. Any experience of this longing, either in oneself or others, is cause for delight. This is because it brings with it its own insight, and therefore the seeds of its own fulfillment.

The psychotherapist needs only to be aware of this force, in his patient, and to keep it within his vision. Then he may enjoy his work, and need never bog down in boredom. His task is simply to watch, as the person in front of him wrestles with well-nigh paralyzing conflict, for the emergence of what he knows is there: man's inherent longing for relatedness and for meaning. The therapist is an observer and a catalyst. He has no power to "cure" the patient, for cure is entirely out of his hands. He can add nothing to the patient's inherent capacity to get well, and whenever he tries to do so he meets stubborn resistance which slows up the progress of treatment. The patient is already fully equipped for getting well. He longs for health more than anything else in the world. Just because this longing may be disguised, does not mean it doesn't exist. It simply means the therapist is blind to it, or has not yet succeeded in discovering evidences of it. Psychotherapy proceeds on a principle basic to medicine: that the cure lies within the patient. Frequently it can be strongly sensed on the first visit. The therapist can well afford to feel confident and contented in his work, for in every person who presents himself to him, the forces of health and hope are stronger than those of sickness and despair. His confidence is increased by knowing that this state of affairs is entirely independent of him. He does not have to "do" anything to make the patient well. Since he is not "responsible" for the cure, he is free to enjoy the spectacle of it taking place.

This is not to imply that he is unimportant to the patient. Just the reverse is true. It is his detachment, optimism, and simple enjoyment of the human interaction involved, that makes the atmosphere in which cure can take place. Psychotherapy is an extraordinarily potent form of treatment. It undoubtedly helps more people, and saves more lives, than any other branch of medicine. This it does by allying itself directly with the source of cure: the patient's longing for order and comprehension. It seeks, in fact, to put at rest all other strivings.

The agency of this work is the therapist's capacity to listen. This is not a passive process. It is an energetic and purposeful activity. The therapist listens, in every expression or gesture through which the patient tries to make himself understood, for the striving toward sanity. If he could always understand what the patient is trying to say, he would smile with utter delight at every communication. For the patient is always trying to get well. He never for a split second turns away from this goal. He is at all times being guided by the longing in him which "knows how" to reach it. But of course the therapist's understanding is limited, and he may be confronted much of the time with behaviour which appears to him as the very opposite of health-seeking. At such times he can only be silent and wait. He is not required to see into everything. He may, in fact, have any number of emotional blind spots of his own. They will not obstruct his work if he will simply wait, whenever something in his patient fails to please him. His reward for this restraint is immense; his waiting presently gives way to a new and refreshing insight. That which looked "evil," callous or bewildering in his patient, suddenly falls into place. Faith in, and a quiet affection for, this person is justified, after all. And now the therapist has learned something new, for his eyes are opened to that which is delightful in man, where previously he could not see it. It must be in this sense that Erich Fromm says "the psychoanalyst is cured by his patient. " 1

Psychotherapy seeks to conserve everything. It does not want to "stamp out" that which appears destructive, because when the whole is seen, nothing is destructive. Every communication is a plea from the patient that the therapist see his basic striving. In this respect, the patient is generous toward the therapist's limitations; he is glad to communicate ten times for every once that he is understood.

All he asks, tacitly, is that whatever he says or does, the therapist stand firm in his good faith, not be shocked or disturbed, but wait--potently--until he understands.

Listening is the only activity essential to psychotherapy. In practice, the therapist may do much else. He may question, interpret, advise or even rebuke. He may conduct an entire therapeutic hour simply by registering in his expression the emotions which the material calls up in him--surprise, amusement, bewilderment, delight, friendly concern, astonishment, incredulity, and pain. But these supplementary activities serve merely to emphasize his listening, both for himself and the patient.

To be listened to is, generally speaking, a nearly unique experience for most people. It is enormously stimulating.

It creates a sort of "interpersonal vacuum" which the patient must fill up with his own ego. It gives him room, perhaps for the first time in his life, really to expand.

Hence, it is exciting. But it also holds him rigidly responsible for himself, his thoughts and opinions, and is thereby threatening. For once, the patient is all-important. For once, everything which he has to say will be taken seriously. It is small wonder that people who have been demanding all their lives to be heard, so often fall speechless when confronted with one who gravely agrees to lend ear. Man clamors for the freedom to express himself, and for knowing that he counts. But once offered these conditions, he becomes frightened.

This is because self expression invariably exposes one to attack. The patient often interprets being quietly listened to as a mounting condemnation of himself. At such times he seeks expressions of continuing trust and affection. But these the therapist cannot always give him. Love does not express itself on command; it cannot be called out like a dog to its master--merely because one thinks he needs to see it. Love is autonomous; it obeys only itself. For the therapist to say: "that is all right; I don't disapprove," without being bidden to it by his own unconscious, would be a betrayal of his deepest trust. This is: to teach the patient that health does not lie in our petty surface designs. It exists, independent, in the depths of the unconscious, and the work of therapy is to learn to abandon oneself to it.2 The therapist cannot express love simply by an effort of will--or can do so only insincerely. His task, rather, is to permit love to be expressed through him, choosing its own time and place and method. If he will wait for this to happen in him, he is following a sure guide: the response in his own unconscious to manifestations of the patient's longing. He will, in fact, sometimes find himself smiling with warm pleasure at things quite foreign to his conscious standards, and may not understand how utterly appropriate this was until later on.

If therapy consists of a spontaneous interaction between patient and therapist, rooted in the unconscious of both3 how, then, can it be regarded as scientifically based? The answer depends on which end of it is brought under scrutiny. If you view it at its advancing edge, as it is unfolding in the present and stretching toward the future, it is not in any way "scientific." This is because its source is beyond reason and logic, in the unconscious of both participants. Therapy is a fluid interplay, sometimes a contest, sometimes a jointly cooperative venture, always in motion, always changing. It is inconceivable that conscious and rational disciplines like those of science could adjust sufficiently flexibly to its requirements. The deliberations of consciousness are much too unwieldy. No more could one choose in tennis, from among a list of rules, as to how the ball should be hit. Deciding ahead of tune how one is going to play the next shot, is almost a guarantee that it will go wild and out of bounds. Good play requires, rather, that one be moved by his automatically conditioned reflexes to the point and attitude necessary for making the most effective possible return. The role of consciousness, here, is simply the will to give oneself over as fully as possible to the game.

Yet psychotherapy is scientific; so is tennis. If you ask the player: why did you decide at that moment to lob? he will answer: because I saw that my opponent's weight was forward, and that it would have been impossible for him to check his impulse to rush toward the net sufficiently rapidly to get back to where my shot would land behind him. Here the "reason" given is accurate, and no mistake is made unless the player thinks his capacity for reasoning was also originally responsible for his decision. Of course, it wasn't. His choice of shot was made in an area that adjusts to the condition with lightning speed. That is something which the cumbersome processes of reasoning cannot possibly accomplish in time to be of any value in the situation. Yet the decision conforms vividly with what is most "reasonable."

The wisdom of the unconscious is not scientific. Nor is it unscientific. It is, rather, more than scientific. The source of all that is of value in man is his deepest unconscious drive: his longing for order and comprehension.

One of the derivatives of this wellspring is man's noble capacity for reason--for observing the causal dimension to which his universe conforms, for discovering the laws of its absolutely predictable determinism. The entire universe is "scientific" for there is no phenomenon in it which deviates from natural law. But even science would remain sterile and frozen if man could not recklessly abandon himself to his longing to understand that which lies beyond what is already known.4 It is not with his intellect that man reaches for the unknown, but with his longing. Reason then refines and makes explicit that which the unconscious apprehends. It permits us to remember, and to communicate, and it gives us the reference into which our new experiences may be framed. This is why psychotherapy must be scientifically based, and why training in its disciplines is essential. Otherwise, every therapist would be wholly a law unto himself, and every patient would be at the mercy of whatever unconscious distortions obtained in his life, about which he lacked insight. The therapist, while he is actually engaged in his work, is and must be a law unto himself. This is because he is at every moment, meeting a situation which has never previously been duplicated: an issue in the interpersonal strivings of two unique individuals. But the moment each new experience is past, it must be made an integral part of him. It must fit in with his previous understanding. It must also be able to make sense when compared with the communications of other therapists. The therapist must know that his work, no matter how "intuitive," is nevertheless bound firmly to natural law governing the causal chain of mental processes.

For no phenomenon has ever been discovered, either of "matter" or "spirit," which escapes from this law, and Freud's rigorous determinism cannot be reversed by all the attacks which offended people have made on it. Man is truly free, in the fullest and most magnificent sense of the word, and it may be conceded that Freud's work brought him to only the most rudimentary grasp of this truth.5 But this freedom cannot be discovered on the level of awareness represented by reason, logic and the scientific discipline to which throughout his life, he gave such faithful allegiance. Man's freedom is self-evident. It cannot be made "scientific," or "proved," any more than can his existence. It can be apprehended only on the level of understanding which underlies science itself and which makes it possible. Man is free in so far as his life becomes comprehensible to him, and acquires meaning, which is to say: in so far as it expresses his basic longing. It is precisely on this level that the communications between psychotherapist and patient are rooted.

Psychotherapy is designed, in other words, to lead--or drive--the patient to see that about life which is self evident. This is why it is so difficult and sometimes takes so long. The patient has spent his life believing about himself, his god and his world what he is told to believe. This leaves him dissatisfied, because something inside whispers to him that the authority to which he is clinging is not final. So he sets out to find one more adequate. He rebels and turns to destroy his old certainties, so as to be free to look beyond them.

In healthy relationships, he simply withdraws from them, by mutual consent. The parent not only loves the child but respects his developing independence. It is on this growing respect, in fact, that his love feeds and without which it would dry up and die. In less healthy relationships more force may be called into service of the rebellion. An adolescent girl is driven toward getting pregnant not so much by sex as by a desperate need to declare that she is a seperate person capable of functioning for herself. This is, in any case, what brings her to the brink of pregnancy. Once in that position, she may then be toppled over it by a sex drive which is in itself still very feebly developed.

During all of this, she acts the part of one driven by genital lust and may persuade herself, her age mates and the juvenile court judge that she is more interested in sexual experience than in growing into independent adulthood. Actually, the meaning of her behaviour is precisely the opposite of that; the sexual avenue is chosen simply because all other means of self expression have been closed off to her by the clamor of authoritarian voices telling her what is right, what wrong, and what the "truths" of her world are. Her movement in the direction of pregnancy may threaten to set in motion a complex tragedy. But it may well contain the only striving toward health which could be unearthed in a therapeutic setting: the longing for a more reliable authority in which to place her trust. Blindly, it is true, but resolutely, she is turning from outside allegiances to something within herself. However, undesirable a pregnancy may be, this shift in loyalties is the absolute prerequisite to her getting well. The therapist's work is to discover this shy longing hidden behind the screen of symptoms, and let himself be won by it. The statement is redundant, for the discovery, once made, evokes its own warm smile of pleasure. When this happens the instinctual threat begins to vanish. The youngster begins to catch sight of what she really wants, because she sees it reflected in the therapist's face. She is quite happy to let sex wait until she is bidden to it by something more convincing than the claims of mere defiance. She has moved a little closer to that which is self-evident, which in this case is: that freedom of choice is the very essence of her life, and she doesn't really have to make such a fuss to demonstrate it.
The same thing is true of the impulse to suicide which, however monstrous its psychopathology may otherwise appear, always reveals its own sad longing for wholeness. The suicidal person is also threatening to initiate a tragedy of complex meaning. But his impulse to "take his life"--into his own hands, is something which one could refuse to grant only by losing all feeling of common ground with him. The desire to take command of his own life is the very one therapy seeks most to nurture in the patient. To deny him it merely for the sake of saving his biological life, is to abandon the basic human trust we are setting out to teach him. I have never yet interfered with a patient's right to take his life. While my experience with suicidal crises is by no means negligible, I am aware that there are all sorts of suicidal emergencies I may have yet to encounter. But somehow, it is inconceivable to me that I would ever feel justified forcibly in interfering with the life of someone who has asked me to help him. When the therapist loses sight of the basic longing in someone threatening violence to himself, he has a right to feel alarmed, but not to throw away his trust, and interfere. As with the rest of therapy, he need only hold on, and wait for understanding.

As always, his doing so is enormously rewarding. The suicidal impulse, when finally understood, can only intensify the affectionate regard in which he holds this person. All the patient is trying to find out is that love and trust are real, and final, that they actually exist, and that they do not depend on his keeping an agreement to remain alive an hour from now, or the next day. A therapist who becomes aware of what a suicidal patient is really trying to say can only experience profound tenderness for him, however uneasy he may otherwise be. This tenderness, once present, demonstrates to the patient that the very ego which he thought was totally blocking the experience of love, and so must be destroyed, has itself communicated a most poignant message of love to the therapist. This is: that love and trust are valued above life itself. An ego which can say this, through its very wish to die, has made a most touching appeal to anyone who will hear. Once heard, it need no longer die to prove its conviction.

Self-murder, the violent impulse to kill and the guilty need to be killed, are only the pathological, secondary aspects of the suicidal impulse. They constitute the last gesture of an ego whose need to express its longing has gone totally unheeded. But the essence of suicide is, as in all human impulses, profoundly healthy. This is: the longing for death. The longing for death is not pathological. It is absolutely inseparable from the longing for life, and always joined to it. It is precisely the inability of a man to see -- and at times to long for--death, that keeps him unable fully to experience the delightfulness of living.6 I have been describing man's deepest need as a longing. This is a longing for knowing that one has roots, that one's existence reflects the order and trustworthiness and utter "sanity" of the universe itself. It is not simply a longing to be biologically functioning. Rather, it is a longing for some absolute awareness of relatedness. Out of this basic human need springs man's capacity boldly to seek to understand the death which awaits him, and at the same time to experience all the exuberance which life brings him. The proud and lonely longing for death of the suicidal person need never be suppressed. Rather, it should be cherished. Given room to expand, it inevitably develops into a wide-eyed, vastly refreshing, child-like awakening to life. The suicidal impulse, when warmly nurtured to maturity, opens out into that which is self-evident. In this case, this is: that life and love are inseparable, that one cannot exist without the other and that as long as life is present, the love which sustains it can always be found.

It may be that the suicidal person is closer to real health than the one who is less dangerously disturbed. Acting on the all-or-none principle, he signifies by his threat his refusal to accept life on any foundation than that of its own inner, and as yet undiscovered, authority. Everything else, for him, has cloyed and lost its savor. The less violently restless person may cut himself boldly free of the old authorities controlling his life, and then just drift to new ones. He may, in that case, remain just as far removed as ever from that which is self evident. The rebellious adolescent may successfully wrench himself free of his parents, only to invest a gang of his equally confused age mates with the authority for his existence. The religious seeker may turn in defiance from the traditions of his elders, and then swallow whole the ready made certainties of a new dogma. Social, economic and political rebels may discover "communism," "free enterprise," "intentional community," "pacifism," "strength through force," "psychoanalysis" (when used as a way of life, rather than as a cure), various kinds of "primitivism," "voluntary poverty," "free love," "vows of chastity," and all the other "isms" and formulas by which life may be packaged into manageable bundles little enough to be intellectually possessed. Every one of these has merit in itself, and may for a while command his enthusiastic allegiance. But if he cannot move beyond them, he is then left clinging for the answer to his own life, to rules and maxims which somebody else has made up for him. This may be a comfortable enough position to quell his restlessness, perhaps for a lifetime. It even may, if it is not too rigidly doctrinaire, permit him room for creative expression within certain carefully prescribed limits. But it does not lead to a life of much depth and adventure.

In psychotherapy, such a person faces a new kind of authority. It proves, if the therapist will hold sufficiently boldly to it, far less vulnerable than any he has found before. The patient's unconscious longing becomes, in the psychotherapeutic setting, the authority for cure. It is that which knows what is right for that person. It knows, as does no other agency, how to find the way out. All it requires is an atmosphere of trust and non-interference. This the therapist supplies. The therapist reflects back to the patient this inner core of health, often long before the patient has any conscious awareness of it. The patient may not fully understand this, even when his questions about treatment are answered, sympathetically and candidly. He finds himself bound ever more firmly into treatment by the unshakable authority with which he perceives it to be invested. But he cannot conceive that there is something within himself which can command such extraordinary confidence. He has spent his whole life abiding, as well as he could, by answers supplied him from the outside. It is not easy under these circumstances to believe that the source of all human potency, creativity and joy underlies the ordinary self of his familiar life. This is the very ego which has been looking everywhere, timidly, dependency, beseechingly for just these qualities.

It is too much to encompass all at once, and it may take a long time for the endless chain of doubts about it to be worked through to a point where he can continue on his own.

Furthermore, he doesn't trust the beast which he has, in obedience to his previous authorities, stuffed back inside himself. What of lust and violence? Of these, he has been so deathly afraid that he has been willing to see them everywhere but within himself. What of self-forgiveness? It may be possible to forgive all manner of evil, perhaps even murder. But is it really possible to forgive murder of the innermost man? Will not all that energy, accumulated for so many years, burst out in an uncontrollable explosion if once released?

Only the therapist knows that he need not fear. The longing which lies at the root of the patient's life has not been dismayed or alarmed at finding so little expression. It is the very source of gentleness and self forgiveness. The more fully it is set free, the more rapidly does it lead the ego into new patterns of change and growth, so as to make it more nearly adequate to the life of increasing potency which it mediates. And, for all its quiet warmth, it tames the restless beast with a voice of final authority, and makes it serve its own ends. There is nothing else in the world which can do so; only man's longing can bring his instinctual cravings under control. As the basic drive of human life which gives rise to the biological energies in the first place, it is always their master. To prove it, it needs only that they be utterly freed from repression--for you can hardly demonstrate mastery over a wild and savage beast when it has been tied and gagged into helpless immobility!

All this the therapist knows, not because he wants it to be so, or thinks it should be, but because his experience tells him so. But the patient does not. He cannot function from the longing that lies at the center of his being precisely because he has stuffed his instinctual energy back into himself. Longing may still show itself, but now it is anemic, for most of its force has been captured by a beast struggling under the weight of repression. In that situation, the beast becomes much more dangerous. Part of the reason for this is the additional energy it must appropriate to keep up the struggle. Another part is that it learns treachery. Out of sight of the conscious watcher, it carries out its designs unimpeded, driving the individual hither and yon to do its bidding, and wearing just enough "respectability" to blind the ego to its nature. Its once noble animal aggressiveness sneaks out dressed as moralistic condemnation, and threatens (in the name of virtue) to destroy the very world itself. Its fine, sturdy lust abandons all the depth and thrust which would characterize its original, periodic rhythm. Instead it spreads itself out into the continuous, shallow sexiness that blankets our nation. Longing, under these circumstances, loses its potency, for it is dammed back behind the repression. Only the palest remnants of it may still appear, in the pathetically overdone cheeriness of our culture, or the frail yearning for someone who can solve our problems for us. It is not the beast which the patient need fear, but his unwillingness to acknowledge and befriend it.**

So the patients come, hiding their nature and concealing their strength, to treatment. What they present to the therapist is the carefully designed impotence that will not offend--or the bumptious aggressiveness through which they try not to see it. Perhaps they are, by surface description, a sorry lot. They often seem weak and aimless, lacking direction or conviction, sometimes absurdly self-important, complacent and opinionated, at others obsequious and ingratiating. They present every conceivable picture of faintheartedness, overt or camouflaged. They usually don't even know what they mean by asking to be "cured" for they cannot picture themselves at full stature. If they could, they would be frightened half to death. They don't exactly know why they have come, or what they want. But they come, ready even to present themselves as abject and ridiculous objects for the therapist's scrutiny. And they hope against hope that here at last they may break the monotonous repetition of their lives: the cycle of provoking from everybody they meet precisely the response they want more than anything in the world to avoid--of provoking it directly, or its polite and insincere opposite. They come, taking a long, long chance on finding something new.

It takes enormous courage. Behind the facade of emotional stupidity and blindness is the longing which has brought them here. It is the wellspring of courage, of insight and freedom. It is always there. In the most hideously destructive mother of a schizophrenic youngster it waits timidly, to be recognized. It drives her to a grotesque, perhaps even monstrously flippant, self characterization before the therapist. This is the only way she has to communicate her despairing need for help before she destroys her child. It is present in the four year old who, on being told that his brief series of interviews is approaching its end, says: "I hate Cissy!" and thereby challenges the therapist so to abandon him in his hour of need. It lies behind the grovelling cowardice of the boy, frightened of his sexual lust and terrified of the ultimate Hell that is preached to him in home and church. In this case, it taps out its message in missed appointments, and lateness to those that are kept--and hopes the therapist will take the hint and please try to understand what real terror is like, what its life and death roots are, and what immense courage it takes even to come to this office, where one might meet it face to face.

Sooner or later the therapist discovers, if he keeps his senses open to it, a strange reversal in the relationship.

It is not just the patient, but he himself, who is under scrutiny. Behind the facade, something in the patient is quietly watching him. It studies him, looks for every conceivable way to help him, laments his weaknesses and delights in his strength. It judges him impartially, even affectionately, but always with detachment. It is the same clear-eyed longing that brought the patient to treatment, and that knows what he seeks. It prods and guides and leads the therapist at all times, and he need only keep his eyes fixed on it, or wait until he becomes again aware of its presence, to take the cues for his response. It is always present. When he gets into trouble, he need only stop what he is doing and wait for it to guide him. The therapist listens for this guide with his own unconscious, recognizes it by its self-evident rightness, and strives to live up to it. If he fails at first to hear it, it will bid louder for his attention. A schizophrenic girl develops a warmly affectionate attachment to the therapist, based overtly on her gratitude for the marked improvement in her symptoms.
At first genuine, and delightful, it stretches on and on, lulling him into a contented drowsiness. Then one day he is startled to hear the words: "going quacking to the doctor" and finds his patient, still smiling and affectionate, idly quoting one of her friends referring to him as a "quack." Quick, wake up! --his guide is urgently whispering--there is still time, but not much, and there is much, much yet to be done.

No matter how sick, insensitive, or even panicky a patient may be, there is always present in him that which sees with a clear and quiet eye exactly what the therapist is doing.

This is why he never needs to overemphasize what he says, or to repeat him-self--for it hears his every contribution, whether acknowledged in consciousness or not. It is never unkind to him, and it forgives all his weaknesses, so long as he keeps trying. It wishes him well, but is not deceived about his mistakes. Big or little, it is endlessly patient in teaching him how to correct them.

But there are some he cannot correct. The therapist grows and changes, but not as rapidly as the patient, for his need is quieter. The core of his ego, during the treatment span of any one patient, remains relatively stable. Its fixed inadequacies are too deeply rooted to change easily.

The therapist does not know what they are, but he knows they are there. He knows, furthermore, that sooner or later they will be on exhibit. He cannot hide them, need not parade them, and has no call to apologize for them. They exist, and represent the limits to his adequacy at any given time. But it is they, and nothing else, that decisively set the limits to treatment. Sooner or later the limits to his sensitivity are reached. Beyond them the patient cannot make him hear, for his own inner fixed wall of defenses, shuts the message out. There are some things about human life that are simply beyond his comprehension.

The patient may be telling him things between the lines, which are of heroic proportions. But they are too big to be grasped; and the therapist looks back with a bland, unseeing eye. Who can, for instance, comprehend the infant's craving to join its mouth to the breast--except perhaps in momentary flashes of partial insight? And yet the patient may be trying to tell us of it, and unless we can hear him, there may be no other avenues for further progress in treatment. Thus, sooner or later, treatment ends, because the therapist can no longer hear what he is being told. Months or even years later it may suddenly dawn on him what he has missed, and he will be amazed that he could have been so deaf. Then, at least, he can carry another patient beyond that point or, as sometimes happens, the same patient, now having forgiven him and returned to "try again." His therapeutic horizons widen through each such episode. But the process inevitably repeats itself; the new horizon is also a fresh limit to his awareness.

Psychotherapy is a process of hearing, when no one else can hear, what a patient is trying to tell us of his own inner longing. When the therapist can no longer hear, it has reached its termination. At that point the patient brings it to a close. He may do this directly, or he may maneuver the unwary therapist into doing it for him. The therapist often wants to blame the patient, for stopping "too soon" or for getting into a rut and becoming "untreatable" further, for it is painful to be no longer master of the situation. But if he keeps his senses open, he will always discover that it was not the patient who so stubbornly refused to understand, but he himself.
This is true, above all, in the treatment of schizophrenic patients. From the point of view of an interest in human longing, schizophrenia appears, not as something "bad" to be gotten rid of, but as a fascinating example of infantile longing, so persistent as to break through the years of ego concretions much as a green shoot cracks and shatters a sidewalk. A schizophrenic episode is in one sense a catastrophe to the individual, and to the family whose group illness it represents. In another, it is a cataclysmic awakening to the freshness and sensitive awareness of infancy. It represents not just an illness, but potentially also a gigantic step in growth. The schizophrenic is one whose entire ego structure needs, in large measure, to be regrown, because the old one has lost its capacity to integrate new experience. The need is so urgent that everything becomes sacrificed to it, in more or less degree. Nearly all previous experience is repudiated, in favor of a fresh start. The result is a nearly naked longing, unprotected except by such crude defenses as massive withdrawal, on which the schizophrenic so heavily relies. Longing would seem, at first, to be much more easily accessible in such patients than with those less seriously disturbed. By the same token, however, its raw urgency makes the patient exceedingly alert to the therapist's unconscious. Schizophrenics have an uncanny skill in setting traps for the therapist. They threaten to lead him out by a leash of subtle flattery, a marvellously camouflaged appeal to his capacity for moral indignation or even a quiet assault on his very existence as an individual. Any of these maneuvers, when successful, threatens to reduce the therapeutic achievement to a mere clinical or symptomatic cure. But the challenge presented by them makes the therapy of schizophrenia invaluable in the development of the therapist. There is no better way for him to learn, if he keeps his ears open and does not mind being secretly hurt and humiliated at times, what he is really like. As he does so, he learns that schizophrenia is a royal road to human longing, only to the extent that he can replace his own ego with an all absorbing interest in the patient. The therapist's only refuge against such an abandoned and skillful adversary as the schizophrenic ego, is to fasten his attention on the patient's longing to the exclusion of everything else.

He may see it reflected in virtually every communication the patient makes. The schizophrenic adolescent, after confessing his breathless little homosexual orgies in the men's room of a local theater, reveals it with unbelievable eloquence when he cries out: "I hate it, oh how I hate it. BUT THERE'S NOTHING ELSE TO D0!"

It is evident in the young woman who, brought to a seminar, calls out to the assembled doctors: "Let him among you who is without sin cast the first stone," thereby revealing at the outset the massive sexual preoccupation in which she feels herself to be drowning, and her wistful yearning for warmth, forgiveness and love. It is only thinly concealed in the paranoid schizophrenic boy who stands over the therapist, glaring down into his eyes and searching his very soul, finally mouthing his ocean of contemptuous loathing: "You phony bastard! How much do they pay you to come up here and stare at me like that: ten thousand dollars?" For he is right; that is, the grain of truth is there: the therapist cannot bring him the experience of perfect trust for which he longs. The therapist can, however, delight in the shy and overwhelming longing which is so clearly evident behind the rage. For no one locked away and nearly forgotten in a state hospital will waste all that energy, except in response to a hope that is almost unbearable in its intensity. By waiting and listening, by the sheer enjoyment of the contest between the egos, and by his affectionate awareness of the presence of longing, the therapist may confidently hope to lead the young man eventually also to see its utter trustworthiness.
Schizophrenics may be treated by silence, by smiling, by sitting together gazing at the floor, by doing almost anything-- but by speaking only when the words are unpremeditated and come up out of the therapist's unconscious, with their own authority. The therapist and patient learn the lesson of these words simultaneously, for they are new to the consciousness of both. But then the therapist discovers, on returning to ordinary office practice, that this is also the strongest therapeutic position with all other patients. Therapy acquires potency to the extent that the therapist abandons himself to the presence of longing in the patient, and responds to nothing else.

So much for the matrix of treatment: the common ground of human longing that holds therapist and patient together in a basic trust.7 Out of it springs also the detail of treatment: the interplay of egos cooperating together, struggling against each other, coming to grips and drifting apart. This is a different world, and more like a jungle.

Here the two study each other like athletes before a contest. It may be that the patient's scrutiny of the therapist is the keener, for his need is more urgent. The therapist bids well to become one of the two or three most important people in his life. The patient studies him with the penetrating alertness of a child. Unconsciously, for the most part, he memorizes and stores for eventual use all the weaknesses, vanities and egotistical impulses of his helper. He uses this study to test the reliability of treatment to the limit. As his instinctual energy is freed up, he may be too frightened of it to experience it inside himself. Instead, he sees it as an attribute of the therapist, whose hidden weaknesses he has already etched into his awareness. With a grain of truth in the falsehood, he views the therapist at one moment as an accomplice, indulging his lusts and relieving him of guilt, or he turns against his helper as an evil seducer. At another, he sees in him a self-righteous moralist barring his way against any instinctual outlet at all. Sometimes patients maintain such attitudes almost interminably. They deal with the therapist as an anti-semite would deal with a Jew, simply refusing to see that this object of prejudice is actually a human being. But they seem to gauge the limits to a therapist's patience with a precise foreknowledge. They will bring him to the verge of despair, and suddenly reveal an insight of major importance that has silently been taking shape within, all this time. Then therapy settles back into its characteristic direction.

This is: a steady retreat on the part of the therapist, and advance toward him by the patient. The therapist leads the patient out of himself. The patient follows, wondering: What are you like? What are your goals in life? What is your identity? In the treatment setting this question takes chiefly the tacit form: What is it that you want of me? The therapist's answer is always the same. What I want, he indicates by his listening behaviour, is to know what you are like; what is your innermost nature?
The patient sets out to answer this question as a child might start to climb a mountain, mistaking the first line of foothills for the summit. Nor is it possible ahead of time to show him what lies beyond his vision. First he answers with what he knows, or believes, about himself. This has been enough to date for establishing himself in relation to other egos. But not with the therapist, who always waits for more.

This being waited on is bewildering to the patient, and fascinating. Authority, throughout his life, has meant a force that molds one to its own command. It is that to which, since it is too strong to be attacked, one must simply conform. And now here is "authority" so strong that it seems altogether unshakable, which gives no hint of anything to which one may conform at all. What, then, is one to do? Is there no satisfying this person? And the patient responds to this query by gradually marshalling in the treatment relationship all the forces in his life through which he has sought to influence other persons. Dependent cravings, accumulated resentment and feelings of violence, sexual strivings, and the most timid of his aspirations are all brought into the effort to come to grips with this person who steadfastly eludes him. The therapist, to the extent that his insight does not fail him, acknowledges with appreciative courtesy the strength which the patient is mustering. But he himself shrinks steadily out of the picture. He becomes, as it were, "invisible" and "undiscoverable," showing less and less of his own needs as they are replaced by his growing interest in the unfolding life of the patient.
So it is that he eventually comes to "surround" the patient, to become to him everything that every human being has ever been before, and to give him no escape.

He "surrounds" the patient, and in the very act of doing so, becomes unreachable. The "identity" which he turns toward the patient is that part of him which longs only to see that which is delightful in man. This is why he need never bog down in boredom. For he has set his sights on a miracle: the release of human energy at its very source. He knows from the start that he will fall short of this goal. But the adventure of his life is that he may, with each case, move further toward it.

BIBLIOGRAPHY
1. Fromm, Erich: The Art of Loving. Harper, 1956. p. 25
2. Zuger, Bernard: The States of Being and Awareness in Neurosis and their Redirection in Psychotherapy. J. Nerv. Ment. Dis. 121:573-579, June 1955 Support for this statement may also be found in the work of many of the psychotherapists who work with schizophrenics, as:
Searles, Harold F.: Positive Feelings in the Relationship between the Schizophrenic and his Mother. Int. J. Psychoanalysis 39:1-17, 1958
Stierlin, Helm: The Adaptation to the "Stronger" Person's Reality. Psychiatry 22:143-152, May 1959
Fromm-Reichman, Frieda: Notes on the Development of Treatment of Schizophrenics. Psychiatry 2:263-273, 1948
Hill, Lewis B.: Psychotherapeutic Intervention in Schizophrenia. Univ. Chicago Press, 1955
Will, Otto Alien, Jr.,: Human Relatedness and the Schizophrenic Reaction. Psychiatry 22:205-223, Aug. 1959
3. Fenichel, Otto: The Psychoanalytic Theory of Neurosis. Norton, 1945. p. 27
4. Bronowski, Jacob: Science and Human Values. Julian Messner, Inc., 1958
5. Knight, Robert P.: Determinism, "Freedom," and Psychotherapy. In: Psychoanalytic Psychiatry and Psychology, Vol. i, R. P. Knight, Ed. Int. Universities Press, 1954. p. 370
6. Wahl, C. W.: The Fear of Death. Bull. Menninger Cl. 22: 214-223, Nov., 1958
7. Erikson, E. H.: On the Sense of Inner Identity. In: Psychoanalytic Psychiatry and Psychology, Vol. i, R. P. Knight, Ed. Int. Universities Press, 1954, 351-364
24

Download File:
[ rtf ]