The Internal Soliloquy

My name is Vincenzo Conigliaro. I am a psychiatrist and a psychoanalyst. I practice psychoanalysis and psychodynamically-oriented psychotherapy. This is a book of stories—my patients’ and my own. This is not a memoir or an autobiography. It is a teaching text, written for the benefit of mental health practitioners of varying experiential levels as well as for people in all professions and walks of life who desire a greater understanding of interpersonal dynamics. Borrowing from Oliver Sacks, “Psychotherapy begins and ends with stories…” Stories—in this case—are the memories, the thoughts and the feelings, which flow—verbally and non-verbally—between therapist and patient over the course of treatment. But if this is true, why are some of the most significant stories never spoken of in psychoanalytic sessions? And why are some stories of great impact merely hinted at, left largely untold, like icebergs floating under the water line, their visible tips belying a more awesome and powerful mass below? Patients tell therapists their stories and these stories may not make much sense to the patients (and sometimes, at least initially, not to the therapist). But good therapists qualified in heart and mind to heal their patients, help their patients make sense of their stories, which may have a liberating effect for the patient. And in listening to the patients’ stories, and in helping patients make sense of their stories, the therapist’s memories, thoughts and feelings about past happenings and interpersonal encounters—the therapist’s own stories—may “resonate” with the patients’ stories and come to the therapist’s own mind. And when a true “resonation” occurs, the therapist’s own stories that come to his or her mind need not be a problematic “counter-transference”—problematic, that is, in causing “problems” to the patient and the patient’s treatment. As the psychotherapist listens to the patient, he engages in what I call “the analyst’s internal soliloquy.” This entails thoughts and feelings, conjectures and speculations, fantasies and hypotheses about the patient’s heartaches and problems, the patient’s manifest and latent communication, his or her psychodynamics. When clinical judgment recommends it, the internal soliloquy regarding the patient, in part or in its entirety, can be shared with the patient: healing interventions and interpretations; and the internal soliloquy concerning the analyst’s “resonations” can also be shared with the patient; judiciously, appropriately, and when—again—clinical judgment recommends it. This sharing may have, for the patient, even more of a liberating effect: “What? Even you, mighty, omnipotent therapist (father, mother), even you have gone through this pain?” The decision for psychotherapists to share or not to share personal memories, thoughts and feelings with patients is a constant issue. It is both an intellectual and emotional tightrope in which the analyst must learn to traverse effectively; how to gauge accurately what is appropriate and not appropriate to reveal. This book was written to support therapists, those just starting out in the field and those who have practiced for many years, as they wrestle with the question of what they should or what they should not tell their patients about themselves. It is not without consideration that I’ve given this psychoanalytic dynamic a Shakespearean-influenced moniker: “the internal soliloquy.” What a therapist might experience, interpersonally when listening to a patient is not unlike what people in any profession might experience when hearing a friend or loved one, family member or work colleague, discuss a difficult problem or a painful emotional issue. But what differs is the vocational responsibility of the analyst to respond (or not respond) to what is being said to them (by patients) in a manner they believe will produce a positive impact on the treatment. Thus, therapists, if they are to excel, must pay close attention to—must analyze—and must interpret their internal soliloquies just as intently as they pay close attention to, analyze and interpret their patient’s problems. The ability of an analyst to listen with a “third ear”3 —to hear and make sense of his/her own past voices, the conjectures and the fantasies—the angers, joys, sorrows and laughs; the myriad of memories, thoughts and feelings flooding their own conscious selves as they open up their hearts and minds to their patient’s stories—their patient’s external soliloquy—is crucial. Yet this subject is seldom lectured upon, seldom taught and seldom written about. This book is also about my deep love for my profession. Being a psychoanalyst and psychotherapist gives me the opportunity to “meet lives” (in the most profound sense of the word: connect with, encounter, reach, understand, “touch the lives”) of other human beings. And, at least with patients with whom I work in depth and with whom I do dream analysis, being a psychoanalyst also gives me the opportunity to embark on a truly fantastic voyage, a voyage with the chance of catching glimpses of the human unconscious: the immeasurably deep, magnificent, intimidating, awesome human unconscious. Another reason why I value my profession as much as I do is because of patients’ capacity to propel their therapists down the road to all kinds of memories about themselves. The patients have the capacity to make their therapists relive their life, thrusting their psychotherapists down the royal road to their own (the psychotherapist’s own) unconscious: for better and for worse, happily or unhappily, with feelings of pride or feelings of shame, but, ultimately, in ways that may enrich the therapist’s psychic life and further expand his or her consciousness. This is a book for psychoanalysts and psychotherapists, and I believe it is a book that can be very helpful to beginning psychoanalysts and psychotherapists. It is also a book that can be of intere