Talking to Patients about Things They Don’t Want to Know

Talking to Patients about Things They Don’t Want to Know

The meeting will consist of  moderated small group clinical workshops. They last about ten hours over a series of session in a small group. They use the CCM method to discuss a presenter's work (usually two sessions) in depth. The workshops are informed by the ongoing work of the CCM Association for the past sixteen years and informal large-group presentations about the Moderators' groupwork over the last year - this year focusing on the theme talking to patients.

The CCM method, originally developed as part of the European Psychoanalytic Federation's Ten Year Scientific Initiative involves structuring discussion in steps - ordinary clinical discussion focused on the presenter's work in the sessions, close focus on the function of each of the presenter's interventions (Step 1) and construction of the presenter's working model of psychoanalysis (Step 2). These formulations are then further discussed in the moderators' group some months later and the overall thoughts fed back to the workshop group and the presenter.  

Each day there will also be large group meetings which the chance for the thinking that has taken place in the moderators' group since the last year to be shared and discussed. 

This year's theme 
has emerged from the 2016 workshops and the subsequent moderators' discussions. 

Most presenters in our groups , like most psychoanalysts, at some point or another believe it useful to talk to their patients about things the patient is unwilling or frightened to know –terms like unconscious, splitting, repression, disavowal are  often used to describe what patients do not know and/or how they go on not knowing. 

The matter raises obvious questions. 

How do we come to know what a patient is not aware they know?  What sort of things do analysts to think their patients do not know or are unwilling to know? How and why do analysts set about trying to make patients aware? What is working through, does it fit in here and how is it achieved?

We have found these questions are especially interesting. Analysts in our week-end groups  quite often suggest their patients are unwilling to know their thoughts or do not wish to recognise they feel vulnerable,or perhaps, needy, dependent, hateful, loving, murderous, cruel, envious, etc. But it is not always clear how this works or how an analyst thinks it can be overcome.

In Vienna in 2016 we had three examples: a patient who couldn't bear to know he felt vulnerable, little and frightened or that these feelings make him behave in omnipotent and controlling way; a patient who can’t bear to know how much he felt dependent on his analyst and a patient whose analyst thought her patient could not  tolerate any interpretation about his relationship to his analyst and so felt this had become a "no go" area.

Some of this seems to have come up in Vienna 2016 because the moderators group had altered the Step 2 formulation. For the first time we were explicit about asking each other how we thought  the presenting analyst thought any interpretations were internalised. And we also tried to ask what it seems has to be done by patient and analyst to make that possible. 

Clearly, how  and what to interpret is central to psychoanalytic work and justifies further reflection. The 2017 meeting will, therefore,  contain some plenary sessions in which moderators will explore this topic further and we hope all present will join us. If any participant wants to present or circulate a short paper please contact us.

09/06/2017 - 11/06/2017
Vienna Psychoanalytic Academy
Vienna, Austria