Attending to the Viscera

Early in my career, psychoanalyst, Erwin Singer in his book Key Concepts in Psychotherapy, (1970), encouraged his readers to get of our heads and attend to our viscera.  His choice of word literally caught me in my gut resonating so powerfully with my experiences with my patient where I felt so many things about them that I did not feel I had the permission to use and yet I knew in my gut – that what was being aroused in my body, elicited in the presence of my patient, had something very important to say about the patient’s life.  There was little doubt, that these gut reactions would eventually (and often quickly and sometimes too quickly) get into my mind and require metabolization but in my raw, gut reactions, I was discovering something fundamental about the patient’s internal world. I eventually made the link that as early object relations and primitive mental states that are split-off and stored in the unconscious – where there are no words, only feelings, that by paying attention to my viscera occasioned by the patient, was the primary, if not the only way to those places of harm that had been cut-off, defended against and projected into others in damaging ways.

The second thing that became apparent, was that as I began to make use my own affective states, on behalf the patient, something shifted in me.  I discovered that I was no longer simply a container/object for my patients transferences and projections but a person in direct relation to another person and that by attending to the affective energy, my own, my patients and in the in- between that is of the two of us acting upon the other, was where change was occurring. It is an odd thing in retrospect that we strove to keep the affective/countertransference reactions out of the consulting room, which is essentially impossible. In every human encounter, we feel something when in the presence of the other and growth is achieved when we can talk about it. 

I have a friend who is quite the character - provocative, emotional, sassy. She recently told me of her (former) therapist, who she was quite certain hated her. From my friend’s point of view she and the therapist would get caught up in all sorts of emotionally charged entanglements, but when my friend would ask the therapist about what she, the therapist, felt, my friend was met with neutral responses. Finally in desperation, she said to the therapist, “y’know there are two people in this room,” and then terminated her work with her.  Knowing my friend as I do, she would be quite the challenge, but in reporting her experience she said, “there was no there, there” and like all of our patients, they need to know we can be penetrated, that we can feel, react and engage in the multiple and complex affective states that are aroused.