There are numerous vehicles for unconscious communication that are non-verbal, for example, posture, gesture, movement, facial expression, tone, syntax and rhythm of speech, pauses and silences. These nonverbal modes of communication are of interest to us. In psychoanalytic therapy, we are working with what lies beyond language. Meaning and unconscious phantasies may be expressed through the way the patient speaks rather than in what he says: a harsh tone, a soft, barely audible voice or a fast-paced delivery can convey far more about the patient's psychic position at the time the words are spoken than the words themselves.
Gestures, including bodily postures and movements, always accompany the speech process. Fonagy & Fonagy (1995) suggest that the power of gestural messages rests in the concealment that they afford, thus offering an opportunity for splitting and denial and so become ideal vehicles for the communication of preconscious and sometimes unconscious mental contents. Fonagy & Fonagy (1995) further suggest that pauses, silences or incomplete sentences and syntactic irregularities should draw our attention to the presence of possible hostile transference and counter-transference reactions. Indeed, patients' preconscious attitudes are often expressed at the paralinguistic level preceding their emergence in the patients' verbal utterances.
Sandra stood at the door of my consulting room for the first time and extended her hand to shake mine. Her gesture was strong and confident. She was wearing a scarf that she took off and threw across the back of the chair she sat on. She looked around the room and said, confidently: ''I like it''.
Sandra did not need any prompting from me to speak. She launched into her acrimonious divorce and the unfair financial settlement. She spoke about her work with the same businesslike tone. I felt swamped and controlled by her as if she had appropriated my room through her confident ''I like it''. From the moment Sandra arrived, non-verbally as well as verbally, I felt that she was letting me know she would find it very difficult to be vulnerable and dependent on me.
Indeed, as the session progressed, a clear pattern emerged: whatever I interpreted, Sandra would somehow find a way of letting me know that she had known this already. For example, she would say ''Good point, yes, I read that in a book'', or ''I agree. I've always known that'', or ''That's exactly what I told my friend.'' It seemed as though the first few seconds of our non-verbal exchange had already conveyed a great deal about what we were eventually able to identify as a conflict about her own dependency.
Listening to silence is also important. At times silence indicates a quiet reflective mood, which is beneficial. At other times it can be a sign of resistance or an attack. The pregnant pauses can feel like a pressure to relieve the patient from his own introspection or the responsibility of thinking for himself. Or the silence may feel difficult to bear because it is being used as a weapon. No matter how difficult silences may feel, we must caution against premature impingement and pressurising the patient to overcome them. We too, may use silence as a way of discharging our own hostility towards a patient. Therefore, it is important to monitor our own silence and ensure it does not veer into withholding or neglecting the patient and perpetuating a misalliance.
Traditional psychoanalytic listening has focused on the process of listening to content, themes, symbolic and denied meaning and metaphors. Nowadays, the structure of the patient's narrative is also considered to be pregnant with latent meaning. The attachment research by Main and colleagues urges us to focus on the meaning that is inherent in the organisation of language itself. Main (1995) makes an explicit distinction between coherent and incoherent narratives. She distinguishes between language that is collaborative and coherent and language that is incoherent, distorted or vague. Incoherent narratives make it necessary for the listener to infer linkages of which the speaker may be unconscious so as to create organisation and to deduce real or underlying meaning in the story that is being told. The distinction drawn by Main encourages us to listen closely to moment-to-moment changes in linguistic fluency and to shifts in voice, to lapses in meaning and coherence and to the fragmentation of the narrative, all of which have been found in research to be indicators of attachment insecurity in adult speech (Main, 1995) (see also Chapter 4).
Slade (2000) suggests that the application of Main's work translates in a focus on the structure of language, syntax and discourse, which may be understood to unconsciously represent the dynamics of an individual's early object relationships. Indeed, Fonagy's (2001) work suggests that secure or reflective patterns of language and thought indicate the presence of an internalised other who can contemplate or contain the breadth and complexity of the child's needs and feelings. In this sense, the breaks, incoherencies and contradictions observed in the narratives of insecurely attached adults are said to imply a break in the caregiver's capacity to respond to the child's need for care and comfort. Listening to the structure of the patient's narrative sensitises us to the quality of his early experiences of attachment and how this might be translated into the patient's current relationships. An important task in therapy then becomes that of reflecting on, and mentalising, those aspects of the patient's story so as to provide a patient with, as Slade puts it:
a secure base for the patient's mind that leads to healing and internal consolidation (2000:1158).
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