Episode 10 - The Case of the German Architect, part 3

In this episode, Deb and Maury address a listener comment about timing when sharing hypotheses with patients. They continue with their textual analysis of the case of the German Architect. They look at ways that Davanloo's words may be conveying epistemic authority, and they consider various interpretations of meaning of the patients' utterances and body language.

Here is Maury's bit of writing on counterpower anxiety:

For Davanloo, striated muscle anxiety is seen as a signal that confirms the effectiveness of an intervention. We assume that anxiety is a signal that defenses are failing and unconscious contents are coming closer to consciousness. Thus, anxiety in the clinical process generally suggests that the therapist’s intervention is working. There are exceptions, however, when anxiety does not point to the effectiveness of the therapist’s interventions. In certain contexts, striated muscle anxiety points instead to the therapist’s failure to listen.

Here is an example:

A therapist has the hypothesis that the patient is defending against feelings of anger towards him. He regards everything the patient says as an effort to avoid this anger. Meanwhile, there is no striated muscle anxiety. If the therapist were listening to anxiety, he would note this absence and begin to wonder if he is “barking up the wrong tree.” Sadly, he continues to listen to his hypothesis, but not to the absence of the patient’s anxiety. Finally, the patient takes a big sigh and says, “I feel you are not listening to me. None of what you are saying is making sense to me, and I feel like you are twisting my words to fit your theory. I need you to hear me."

What happened here? Does this large sigh validate the therapist’s hypothesis about hidden anger? One possibility is that the therapist’s efforts finally broke through the patient’s defenses, triggering a rise of striated muscle anxiety and a new wave of defenses—the patient now attempts to change the therapist’s behavior or control him. Some therapists would see it this way, code the patient’s feedback as defensive, and continue to pursue the anger they believe is there.

Another interpretation of the anxiety, however, is that it is triggered by the risks associated with speaking “truth to power.” The patient openly criticizes a person he depends on but who is not listening. I call this manifestation of anxiety a “counter-power sigh.” The patient is not resisting the therapist’s therapeutic efforts; he is resisting the therapist’s efforts to overpower him (Foucault, 1981; Fors, 2021). No wonder the patient becomes anxious. Who among us has not experienced the dangers that come when we stand up to someone trying to overpower us? The counterpower sigh comes when patients must make a massive and frightening effort to speak openly and truthfully to someone who is exerting power over them, here manifested as the power to interpret what is going on in the patient’s mind. The counterpower sigh occurs when the patient’s wish to save the therapy overwhelms his fear of what might happen if he speaks truth to power.

I am highlighting counterpower sighs here as an important caveat. It is not true that “all signs of striated muscle tension are universally and inevitably signs that therapy is moving along in a positive way.”A counterpower sigh can arise when the patient tries to break out of a sadomasochistic enactment. If we mistake the counterpower sigh for an unequivocal sign that the work is going well, we may continue to enact a sadomasochistic power dynamic and miss the patient’s supervision.

References:

Davanloo, H. (1990). Unlocking the Unconscious. John Wiley.