Learning from the Patient

That’s the title of Patrick Casement’s book, which I first read back in my first year at the East European Institute of Psychoanalysis (VEIP). It’s a detailed account of how psychoanalytic thinking develops. The book describes and analyses the relationship between analyst and analysand, and the way people who come to a specialist “help find the keys to the therapeutic experience they unconsciously seek.” Casement “shows how an internal supervisor can not only catch and correct a range of possible errors, but also produce a genuine therapeutic effect from the analytic work itself.”

The book had me from its first pages — already in the introduction, Casement makes a point I found myself fully in agreement with. To quote: “…a mother can learn a great deal from her own children, above all how to be a good mother, by giving her child what it needs most. And here children teach far more than any adviser or book ever could. The same holds for fathers, who can learn from their children how to become a father. In the same way, analysts and psychotherapists learn from every one of their patients. As a result, they become capable of being different with different patients, or of changing with the same patient as the analytic process unfolds.” He also notes that as children move through different stages of growth, parents respond to them differently, taking their shifting needs into account.

From the earliest chapters, Casement writes that an analyst can never know everything about the person who has come into analysis. It takes time to gather a preliminary history and to begin working with the material a patient brings to sessions. The analyst holds the position of “the supposed-to-know,” while trying to sustain the necessary state of not-knowing. And this isn’t to say the analyst lacks theoretical knowledge — rather, “there is always a certain creative tension between knowing and not-knowing.”

So a new kind of relationship, unlike any other, takes shape in the analyst’s room — one that will gradually develop and produce a therapeutic effect. It matters a great deal that both analyst and analysand feel comfortable and safe in their meetings.