To see or not to see, hear or not hear, feel or not feel

Comments on the book by Sandra Buechler:
“Clinical Values: Emotions that Guide Psychoanalytic Treatment”

Dr. Ramón A. Mon
Panama City, February 24th, 2010


From my reading of Buechler’s book I must note the emphasis that the author makes about the human condition of therapists. Sandra Buechler offers us a special context from which we can review our position as analysts in our daily work with patients. Therefore, we think that this involvement may be entitled: “To see or not to see, hear or not hear, feel or not feel in therapeutic work”.

In one paragraph Dr. Buechler summarizes what she thinks would be necessary for the human development of a psychoanalyst, and lists:
1. Awareness of the physical difficulty of an analyst’s life.
2. Empathy for the moral, ethical, psychological, intellectual and emotional burdens.
3. A supportive relationship with one’s own Superego, which can provides easy access to the feeling of being valuable, well-meaning and other qualities to which I referred to as the “inner chorus” of the analyst.
4. Ability to forgive, that is, reasonable levels of shame, anxiety, guilt and repentance fro mistakes.
5. A persistent identity, despite being the repository of projective identifications.

These requirements are difficult to achieve I would say, and yet turn out to be important in order to See, Hear and Feel in contact with patients during the analytic hour. Therefore, this implies a high quality human and professional development.

As I read the book, which boasts an extensive and very well collected bibliography, I remembered two stories I heard from Dr. Erich Fromm (Buechler cites Fromm thoughout the whole book) in one of the very few occasions that I had the pleasure of listening to him. The first relates to not seeing and the second to not hearing.

“One winter, after completing the consultation in the early evening, I went outside and despite not being very late it was already dark. On the  sidewalk I was walking by, I saw a couple arguing heatedly. Anticipating trouble, I crossed the street and went my way. The next day I read in the newspapers that at that place, at that time a woman had been killed. I then remembered that I had seen something shiny in the man’s hand, probably a knife.”

Fromm had seen and not seen. This samen phenomenon may happen in the analytic hour when the patient brings issues that may be disturbing or threatening, in content or purpose or both. Making an honest analysis, could we consider that after a long and rigorous training, analysts are immune to such conflicts?

Buechler remind us that no, that this reaction can occur because the analyst is as human as his patient and that only thanks to a large dose of narcissism he/she can deny the conflicts that arise during the therapeutic encounter and consider immune to it. A training that involves good monitoring and an ever better analysis, prepares to recognize emotional disturbances resulting from the therapeutic encounter and allows an adequate response to the situation presented by a disturbed or disturbing patient.
“On another occasion, Fromm told a group that he was amazed by the natural ability that some people had to see beyond the simple facts that happened in life and capture the subjective elements of everyday life, despite having no training professional as psychologists or psychoanalysts.  He reported that the lady who worked at his home in Cuernavaca and lived in Tres Marias, a town halfway between Mexico City and Cuernavaca, told him surprised that it had snowed the night before and it caught her attention that solid things can fall from the sky and make no noise. A very pertinent observation on the phenomenon of snow, where usually there is a conspicuous silence.”

Frommm commented that he found that to be a very important observation because having lived in Frankfurt and other cities in central Europe where it snows heavily, it never occurred to him to think of such sensitive detail. That is, he was making reference that one can hear or not hear depending on the sensitivity, the connection with unconscious factors and the quality   of the material heard.

What do theses two stories have  to do with our daily work as a psychoanalyst? The author warns us that we can miss important details of the therapeutic session when we are not intimately connected with our work or when we are narcissistically connected with ourselves and we miss important implications from the patient’s speech. Because we can’t see, hear or feel with him.

Referring to the theory used by the therapist, Buechler reminds us that we can not hide behind the theory to escape the emotional encounter with patients and I quote a paragraph from the book that I found important: “I think we do a better job when we feel the appropriate hope, courage, purpose, curiosity, integrity, ability to bear the loss, and the ability to modulate our emotional responses. But often our equilibrium is disturbed by the inherent difficulties of treatment. We suffer all kind of losses, directly or vicariously. The potential of being overwhelmed by the emotional intensity of the work and its enormous complexity. We are easily overwhelmed by the affection and innundated with information. We are the guardians of countless memories,  untold horrors and painful secrets. Our own atrocity, horror, sadness and discouragement is often provoked…”

Finally, in her most recent book “Making a Difference in Patient’s Lves”, Dr. Buechler tells us:
“Doing clinical work is a daunting task. To focus on so many levels at once, to be in the vicinity of so much heartache, to bear the loss of every treatment partner, to live with the limits and the degree of our influence is an extrtaordinary challenge. But is also an extraordinary privilege… Like the musician, we have to keep our instruments in top form. But for clinicians our instruments are ourselves. We have the audacity and the humility to try to use or own cognitive, emotional and interpersonal resources to make a difference in other’s lives.”

I can strongly recommend the book by Sandra Buechler, it is valuable, makes an excellent literature review and helps us deal with a lot of anxieties aroused by the daily work of a therapist commites to his work.

Thank you,

Ramón A. Mon (


Derechos Reservados Semsoac 2014