Chapter 2--Managing the analyst's needs

To what extent does the analyst need to renounce his or her own needs in the interests of serving the patient??And to what extent does the analyst need to be gratified by or somehow benefit from the relationship with the patient in order for the treatment to progress and succeed??The dialectic between gratification and renunciation is both a familiar one, yet also an ill-defined and perplexing one.?We know that we do sacrifice for our patients.?But we also know that we are deeply gratified by our relationships with them.??The goal of this chapter is to review and integrate the literature on sacrifice and gratification, with an eye toward greater understanding of both what we give and what we receive in the context of doing treatment.?I also want to illustrate how relative those concepts can be both within and across individuals, depending on current emotional state, relationship status, physical well-being, and developmental stages.

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Suffice it to say that the notion of our self-sacrifice gleans far more positive attention than the topic of our gratification and/or our enduring personal benefit resulting directly from doing treatment. Perhaps those who so strongly oppose the idea of therapist gratification do so out of fear that the needed ethic of discipline, patience, and self-sacrifice may be undermined or even forfeited once gratification is accepted.?Yet all close human relationships necessarily involve a high degree of both sacrifice and gratification.

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The idea that these two concepts cannot coexist within the parameters of the therapeutic dyad is counterintuitive.?Yes, a higher degree of focus on the other person, and the ability to quietly listen and accept his or her pain, is part of what distinguishes us from friends, family, and other potential listeners. ?Rather than jumping in with our own stories or rushing to find a solution, we often earn our fees through a sometimes torturous process of silent witnessing. Yet this is not the whole story.

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The therapeutic relationship provides ample room for both healthy self-sacrifice and healthy, mutually beneficial gratification.?Unhealthy sacrifice and gratification also exist, of course.?Sacrifice sometimes leads to deep resentment and an uncomfortable sense of having submitted to a sadistic patient, while at other times it brings the tranquil satisfaction of having relinquished pride and power in the interests of another.?Similarly, gratification, particularly the currently sanctioned activity of “play” in the analytic encounter, can be easily enjoyed and accepted.?But feeling loved, deeply understood, found attractive, or taken care of, particularly at a vulnerable moment in the analyst’s life, may promote guilt or even shame.?How are we to discern when our needs are being met in the interests of the patient or at his or her expense???And when does healthy self-sacrifice devolve into masochistic submission??