In the first phase of treatment, all of our patients interview us. They are checking to be sure that we will be helpful and not harmful.

Patience, the willingness to wait, and curiosity about what is growing beneath the surface of things are, perhaps, two of a psychoanalyst’s most important tools.

In intensive psychotherapeutic treatment the analyst needs the capacity to not know, to contain the feeling of not knowing, and to allow the mind to drift and wander.

It’s all there in the memory banks, but to be effective in finding it, the analyst must be comfortable living with primary process and open to hearing the meaning in metaphors brought by the patient. That requires the capacity to play.

Everyone experiences trauma. It may not be salient or dramatic, such as the trauma of surviving the Holocaust, but it is trauma, for the individual, nonetheless.

Embrace informed ignorance. Be ready for surprises: If we have the willingness not to know and to find out, well that’s wonderful!

These are just a few of the pearls of psychoanalytic wisdom offered up by Dr. Martin Silverman in his presentation of the case of an amazing psychoanalytic treatment of a four and a half year old boy who had dropped out of the world.

The case itself, in which Silverman and his 4 ½ year old patient discovered and worked through the trauma he experienced when his mother left him emotionally during his infancy to care for her dying father, is an amazing testament to the power of psychoanalytic process and to Dr. Silverman’s stellar work.

At a time when the case study is under attack from the evidence-based practice movement, hearing such a case is particularly significant and relevant, as it reminds us that case studies, while perhaps not generalizable, offer powerful insights into the subjective process, bring to life the nature of psychoanalytic treatment, and help all of us, from beginning clinicians to seasoned analysts, to keep in mind the analytic stance that allows us to enter into the inner world of our patients and, together with them, understand and relieve their suffering.

Silverman’s talk, however, did not simply offer up a single case, though it did that with aplomb. In one morning, he also shared with us decades of accumulated psychoanalytic wisdom, as each step in the unfolding of the case of Timmy carried with it an insight into key aspects of the analytic attitude.

In the first phase of treatment, all of our patients interview us. They are checking to be sure that we will be helpful and not harmful.  In order to manage his overwhelming feelings of the loss of his mother, Timmy retreated into his own word—a town in which he was mayor. In order to enter his world, Silverman applied for a job as his secretary. This lovely and playful drama between child and analyst brought to life Silverman’s lesson that all patients interview their analysts. This, he says, constitutes the first phase of treatment.

Patience, the willingness to wait, and curiosity about what is growing beneath the surface of things are, perhaps, two of a psychoanalyst’s most important tools. Bringing the audience with him into his psychoanalytic playroom, Dr. Silverman told us of Timmy’s months-long silence, broken only by the words, “Just wait.” Dr. Silverman’s willingness to wait ultimately resulted in the recovery of Timmy’s traumatic memories of waiting for his mother.

In intensive psychotherapeutic treatment the analyst needs the capacity to not know, to contain the feeling of not knowing, and to allow the mind to drift and wander. Referencing John Keats’ “negative capability,” Silverman shared his struggle waiting for Timmy while not knowing what might transpire or how long he might have to wait. When he was able to allow his own mind to drift and wander, he connected to his own nursery school days, which was unconsciously communicated to Timmy and which facilitated a deeper connection between child and analyst.

It’s all there in the memory banks, but to be effective in finding it, the analyst must be comfortable living with primary process, open to hearing the meaning in metaphors brought by the patient. That requires the capacity to play. By playing in Timmy’s world and by recognizing the connections that the play made to forgotten memories, Silverman was able to be with Timmy as he regressed to the moment of his early trauma. When Timmy re-enacted the trauma in Silverman’s patient presence, it was surprising—and yet not. All is held in memory.

Everyone experiences trauma. It may not be salient or dramatic, such as the trauma of surviving the Holocaust, but it is trauma for the individual, nonetheless.  In a gentle but insistent manner, Dr. Silverman conveyed his deep respect and compassion for all of human trauma. Toward the end of his presentation, in a reverie (or association) about a book that he had read about the Holocaust, he connected all human suffering and reminded us that the essence of our work is to sit with others in the working through of their suffering. That is the psychoanalytic cure, as Freud once said, a cure “effected by love.” Silverman’s love of humanity and of the psychoanalytic process permeated his entire presentation.  In his words, “Embrace informed ignorance. Be ready for surprises: If we have the willingness not to know and to find out, well that’s wonderful!”

 

This post is a review of Dr. Martin Silverman’s presentation for the Center for Psychotherapy and Psychoanalysis of New Jersey (CPPNJ) on June 2, 2019.  You can read more about Dr. Silverman, his publications and presentations, and his practice on his website.