A Political Dilemma

What happens when a patient expresses a feeling or opinion that induces strong counter-transferential feelings in an analyst with passionate political opinions and views? The classical viewpoint, of course, is to keep such thoughts to one’s self. But what happens when the patient exhibits attitudes that are clearly prejudicial and at times even abhorrent to the analyst?

Following the old adage that the personal is indeed political, I am proud of my activism — albeit with age it’s more verbal than active — but at the same time I am committed to creating a safe and empathic environment for my patients.

As an analyst, my role is not to educate about politics or to explore prejudice even if what I hear is hostile bigotry. Yet, when I am confronted with thinking that I find offensive or culturally dangerous (albeit only verbal), my emotional response is the same as it would be outside the office. Do I remain silent? Will my own need for exploration represent my agenda rather than that of my patient? And how do I prevent such thinking from influencing my view of that patient?

Fortunately I am not confronted with this dilemma often. When it has happened, I have remained silent and let myself be with my counter-transferential feelings. But this does leave me wondering as to what might be a helpful and ethical intervention.

A patient of mine had consistently expressed his dislike of lesbians. When he was particularly angry, he referred to them as “cunts.” Since I’m very sensitive to sexism, the use of that word left me bristling. Because I continually remind patients that I want to hear all their feelings, I never responded. But I did struggle silently with whether to explore his animosity (my own agenda) or continually listen as he expressed his anger. Although we often worked on his anger issues, when he used that word I ultimately held and respected his feelings with silence. I often wondered if there would come a point when I might lead my patient to explore his prejudicial views. That time never came.

Many years ago I had a patient who was conservative politically and had no patience, sympathy, or understanding of minorities’ position in society. At one point he referred to Hitler as a great man. I asked him what he meant by that and he referred to Hitler’s power. I did not go any further with the comment, thinking that to do so may feel to him like an attack. Nothing else was said by this patient during the time I saw him that would allude again to the Hitler comment. That comment still haunts me all these years later. I often wonder if and how I might have responded differently to hearing something so abhorrent.

While these are extreme examples, there have been many subtler examples that contribute to this same dilemma. I wonder how much of my commitment to bettering society might extend to my one-on-one relationships with patients. Although I always err on the side of caution, I continually wrestle with how my silence as a therapist ultimately conflicts with my passionate political commitment to affect change.