As an analyst, I wrestle with myself about what stance will be most effective and helpful for my patients. Being psychoanalytically trained, I was taught that the “blank screen” was a most effective approach. After exploring and working in this way, I have abandoned the concept of the blank screen as ineffective and unrealistic.
While the theory behind the “blank screen” has merit and can be useful at times, psychotherapy is a two person psychology. The “blank screen,” while theoretically tempting, is, in fact, illusory. Inevitably, therapists and the people they treat affect each other in a multitude of ways, both verbal and non-verbal, that cannot be controlled by self-imposing an artificial neutrality. As much as we may try to remain “blank,” patients pick up things about us, by transference, projection, deduction and/or exposure.
In the psychotherapeutic setting, we are often confronted with dilemmas about the most effective way to respond and meet the needs of our patients. We continually make decisions about how best to offer empathy to our patients, including when to keep silent. When listening to patients, how much do we self-disclose what we are thinking and feeling? When do we keep thoughts and feelings hidden?
While to some analysts unorthodox, I offer my patients those aspects of myself that contribute to a holding environment. For example, when a fearful and anxious patient chastises him/herself for not being “normal,” I may point out that such feelings or thoughts are common. On rare occasions when I think that a personal example may ease a patient’s self-judgment, I’ll offer a personal detail that helps my patient feel less isolated. One patient talked about how together and organized I am and how she suffers so in comparison. I told her that this self-organization took a lot of time, work, and learning. She was both grateful and hopeful. My self-disclosure left her with the feeling that she too could accomplish positive change.
While such self-disclosure is uncommon, I have used it to offer hope to a despairing patient. There are times as analysts when we can use ourselves as examples and hence ground patients and quiet their self-recriminations. I once had a patient in his mid 30’s who talked at length about his lack of career achievement and focus. He felt it was too late to have a satisfying career and furthermore he didn’t even know what he wanted to do. He used his own expectations and the expectations of society to reinforce his feelings of worthlessness. I told him that I had changed careers mid-life and went on to establish myself in another profession by going back to school for 12 years, an experience which at first was daunting but to which I had adjusted and succeeded. My self-disclosure gave him hope and helped him work through the blocks he created by his self-recrimination and found motivation to explore what he might want to accomplish.
Non-verbal self-disclosure of our feelings can help convey empathy and caring. If I am moved to cry by what I am hearing from my patient, do I hold back and hide my tears or gently let them be known? Often when I tear up or cry, patients feel that I am empathizing with them and feel psychically held. I am careful to let them know that it’s okay for me to cry when I am sad and I make sure they know I do not need to be taken care of. Both my tears and my reassurance that I can still take care of them relieves patients and allows them to go deep into their sadness.
It is of the utmost importance that patients experience me as a human being with thoughts and feelings. At times, self-disclosure can help create a warm and empathic relationship and provides a safe environment vital to the work. It’s vital to let patients work though negative transference and rupture. But to allow that to happen, careful self-disclosure can facilitate the safe holding environment necessary for the patient to freely express all that he/she is thinking and feeling.