K: Absolutely. I think people want feedback. Particularly, as I wrote in “The Power of Countertransference” if they are seeking it, then I don’t understand why you would not be responsive to a direct request for feedback. I think where we get into the delicate issue is when you're not sure, or when the patient is provoking possible feedback but not asking for it directly. Then you have to explore it and make a decision which may or may not include asking them if they want feedback. I think it's a no brainer when the patient is literally saying I want to know what you are really thinking or feeling about me?
M: Yeah, yeah.
K: For example: most of my clients become much more successful as a result of their treatment and they want to know am I going to resent them? Especially if their parents were very competitive with them. If they are too successful will I try to destroy them, take it away?
M: So what do you think benefits your clients in being able to ask you those questions in terms of their growth and development?
K: I think it gives them a tremendous confidence in their own intuition because I think one of the greatest contributions of neuroscience and the whole notion of unconscious to unconscious communication, is that clients already know what we are feeling. We already know what they’re feeling. I think the art is to determine, ultimately, what's most beneficial to actually discuss to get to the bottom of what’s going on. What's important to the work and what isn't. Will some of our ideas, notions shut down the patient experience, I think inevitably yes! That's the nature of relationships, whether it's analyst and patient or mother and child or spouse. There are ways you just cannot relate to someone else or you can't promote it.
M: A client having to contend with the real you rather than just feeling it.
K: You know, I successfully treated someone with severe borderline personality disorder. That was where I first experimented with expressing rage. She thought everything was somebody else's fault. She would talk about her husband and blame the poor guy for everything. He was responsible for every feeling she ever had. She wanted me to endorse that. That he wasn’t sufficiently empathic but he was! He martyred himself for her, whatever it took. She really needed somebody to stand up to her.
M: You made a comment about our culture not leaving room for negative emotions. I see this an an epidemic in parenting. We've got the hover parent generation where parents can't give feedback to their children or they have to sandwich it with so much goodness. To me, it's about emotional clarity, right? Sometimes it's not about positive or negative. It's about being clear with emotions and our intentions.
K: Yes. Being authentic without being insulting or cruel. Finding a way to constructively give feedback, whether positive or negative. So the positive isn’t too over-stimulating or generate too much expectation of a repeat performance. The whole notion of not waiting until your own feelings are so intense that you have trouble managing them and being in control of them when you're talking. It’s easier to be honest when you’re in control of how you feel. Most people white knuckle it. Neuroscience shows us that negative emotions are rarely outside of our conscious awareness. (They are felt and known even if not explicitly acknowledged). So we need to talk about it….
M:. You alluded to something earlier that I’ve been processing for a while, personally. I have a tendency at to be effusive with my language, you spoke to how we can say something positively in a way that is not too overstimulating. Candor is about being clear in feedback. I have an awareness of my tendency to slant towards hope and it has impact. Not always negative but I have to watch it. The truth is I have these little awareness all the time in session and I think ‘bookmark’ I need to go back to that. But how often do we, have the internal candor to take a deeper look?
K: Bookmark is a great word. That’s the beauty of the whole analytic approach. You bookmark it and you're curious about it. You don’t just blurt it out to the patient. You bookmark it and think about it. You wait to see, is this more about me or more about the patient. Because transference is repetitive, it will always come up again, and you don't have to figure it out in the moment.
M: So, what I hear is with candor, there's a certain amount of measure. Working towards an internal space that is curious. Curiosity to pay attention to the tiniest movements inside, an internal honesty that translates to a clinical (relational) honesty.
So with enactments, there can be a dishonesty there. I mean, of course, we fall into things but I think you're putting more onus on the clinician to pay attention.
K: Absolutely, and I think that if you look at the literature most of the enactments are not positive, they’re negative. But if you have transcript of sessions you would see there are just as many positive enactments as negative going on, but we don't yet care about those. Because those generally are not disturbing the universe of the relationship. (laughs) I will notice with a patient that I really like or admire we do this little mutual admiration thing, you know? It is a sense a form of acting out. A little flirtation, something.
M: This is where the awareness comes in. How much of that is unconscious to the analyst?. There's a part of you that's just feeling good and maybe another part has the passing thought..I wonder if this is something?