It would be a hard thing to do—to over emphasize the importance of satisfaction in clinical work.  Your patient’s satisfaction.  And yours! If we’re talking baseball, it’s that sweet spot on the bat.  If we’re talking sex, well—you know that place!  The contact just feels right.  Couldn’t feel better.  And wow—something amazing happens!

So yes!  In a very real way I’m saying let’s hit it out of the park in our clinical work.  Let’s do something satisfying.  Let’s make contact with the leading edge of our patients—the part of the self striving to come into being, and let’s see what wonderful things unfold.

What’s the leading edge?   Heinz Kohut, the psychoanalyst who used the term, and who, in the 1960’s, 70’s and 80’s conceived of the modern psychoanalytic theory Self Psychology, explains that the “leading edge” refers to those aspects of a patient’s “thoughts, fantasies and behaviors which are understood as necessary, and as striving toward self-protection, self-restoration, self-righting, or self regulation.”

A principal that’s central to Self Psychology, and to much of contemporary Relational thinking holds that we strive to understand individuals from within their subjective experience. In privileging subjective experience, this principal recognizes that each person experiences her own unique subjectivity—her agency, vitality, cohesion and continuity.   The closer the therapy comes to facilitating the patient’s experience of her subjectivity, the more the patient is able to become cohesive, enlivened and give voice to the true, authentic self.

Watching out for and understanding the leading edge in a treatment enables us to bring about this kind of growth in the self.  As a requisite for growth, understanding and making contact with the leading edge of our patient’s is at the heart of good, solid, satisfying clinical work.

Here’s an example of working in close contact with the leading edge:

A young woman enters the therapy room 10 minutes late, out of breath, eyes sparkling.  She says without hesitation to her therapist, “you’ll never believe who I saw on the street outside.  (Patient names a contemporary famous female actress, then continues.) She was amazing.  OMG you should have seen her shoes.  I have the same ones.  I can’t believe it.  I have the same exact shoes as  __. ”

We can understand these breathless introductory exclamations made at the delayed start of a therapy session to be the spontaneous and joyous expression of the patient’s unedited strivings to be like and enjoy the similarities between her and an admired actress.  “Look,” the patient appears to be saying.  “I’m admirable since I share a taste for beautiful shoes with a very important person __.”

But we also can understand these breathless introductory exclamations to include the unconscious strivings of the self—to be admired by her therapist!  Thus, the patient is also saying to her therapist, “I long to have your admiration.”

What to say here?  If the Leading Edge of the patient is the enlivened self that we see here, striving to solicit her therapist’s admiration, we can respond by embracing and making contact with that edge .   .   . “I can see what good taste you have”!    I believe this comment speaks to the patient’s unconscious longings for admiration from the analyst, is an enthusiastic expression of admiration, and signals to the patient that her unedited strivings to be seen in this way are acceptable and will be met with a response by her therapist that’s empathic—conceived and offered to privilege the patient’s subjective experience.

Supervision gives us an opportunity to discover your patient’s unconscious longings and to imagine where their leading edge is.  It gives us an opportunity to imagine working at that leading edge.  With the clinical material available, we can come to know your patient intimately.  And we can understand exactly what they’re looking to you to provide, to interpret, to know, to understand.  We can imagine that this leads to a deepening of the work, an increase in the patient’s capacity, a genuine sense of satisfaction for your patient, and also for you as you become the good analyst you know yourself to be.

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