The Clinical Relevance of the Autobiographical Dialogue:
Specificity of Knowing and of Being Known
“You can’t protect other people from their lives (…) It can’t be done.”
“But isn’t there something, I don’t know, something people do for each other?” “Sure there is something… they stay alive.”
“It’s not as simple as it sounds.”
Ted Mooney ~ Easy Travel to Other Planets
Please read this text twice. The first time, read it straight through without bothering about the footnotes, which I have placed at the end of the text to make this possible. Then read it a second time (if you like), with the footnotes. This makes for two versions of the text, with the first being the one that is most important to me, it being (to my mind) more evocative than the text with the footnotes (which will be necessarily interrupting). What I want is not just to engage your mind, your thoughts, your intellect, but to affect your feelings: to reach what is most alive in you as you’re reading, to be seen by you where I feel myself most alive (in this text). The first reading will do this better.
And there will only ever be one first time.
What can I say about the clinical relevance of the autobiographical dialogue when all dialogue, always, is autobiographical? And I do not mean my telling you about myself in so many words. I am not speaking of content (although that, too, will sometimes happen).
The mere fact that I am an analyst and place myself in this position vis-à-vis you, the analysand, is a result and expression of my life and living being, means something to me -- you cannot know what, but it will inform my every move. And the fact that you sit opposite me in this strange configuration in itself tells your whole story if I could only hear it from your still body.
But I can’t.
There is my choice of language: do I speak English? German? Already you know something personal of me as you read this. And when you hear my English, you know that I am not a native speaker. And if you hear my German and know German well, you know I am not from Switzerland, nor Austria, nor even from the North of Germany. And these two languages that I am fluent in narrow down your choice of what language you can speak to me and hope to be understood.
Not these two languages limit you.
My history, and who I am and have been leaves a narrow opening for you to reach me and be reached. What if you wanted to speak in Spanish? I could only understand so much and not well address you. French? I would hear you even less and become more mute. Hebrew? Portuguese? Italian? Hungarian? Japanese? I do not speak them. We could only sit in silence or attend to sounds that would carry little meaning for you and me. Two bodies in each other’s presence (which we also are).
Here, already, who we are -- our autobiography, yours as well as mine –
determines how we can meet and how we can be “we”, if our “we” can include true dialogue.
A give and take.
A responding and responding to a response and responding to that response and responding and responding and responding – in an endless movement taking us into unknown, perhaps heretofore unknowable, territory. Taking us places we did not know we would visit. Placing us at the utmost edge of our personal history from where we strain to reach each other – I towards you, and you towards me.
But if there is no common language…
This dialogue is autobiographical also in the choice of system of thought I – the analyst – might use to address you: my words will be (at least in part) couched in the language of one theoretical approach or another. And the choice of approach – my choice of language of theory– will have to do with who I am and who I have been, which system of metaphors (as such they are) can reach me and speak to me so that I can use it to try to speak to you.
And it will depend on how you can understand and respond to this system of metaphors I use – if it will make you feel understood and met, if you can feel me in it, if you can feel me feeling you in it. If it will carry any trace of my living being into your living being where you can receive me – if you can use it to carry traces of who you feel yourself to be, of your aliveness (or deadness, as the case my be), your being, and convey it thus to me. And that, too, will depend on who you are and who you have been.
Dialogue is also autobiographical in what each of us attends to – you and I. What you tell me, certainly, as surely as what you do not say. What I hear and am moved to select to respond to – what I perceive as that which will serve you best at any given moment -- is based on the entirety of who I am and does reveal me in my every word.
In your omissions and in mine and how we understand them (if we do). The focus is on yours, but there are two of us and what I do not say weighs heavily in the room.
Your silences as well as mine -- and what they mean and might not mean: to you, to me, to us. All based on who we are. All finding shape and form and expression – if indeed they find it – in this crucible of your and my history meeting here and now.
My breathing as well as yours – the breaths you take, and when you stop breathing for a moment, and when you resume. And likewise I. And how we hear this and where we know it and if and how we will ever speak of it.
The ebb and fall of your voice, the music of your speaking – how do I receive you? The way you speak says much about you and how I hear it is entirely based on who I am. And how you hear the song of my own voice – what it unlocks and what it closes down: such waves of feeling – those that I know of and those I do not know of. Those that you know of and those that you do not know of. Those that we dare articulate and those we don’t ever speak of. Those that are too deeply hidden to emerge.
All based on who we are and who we have been.
And now the words themselves: you speak to me, and what I hear is what I have been hearing all my life. I answer from that vantage point, charged with the history of my days, and you hear me and speak from yours. And now, if all goes well, we labor for understanding. Is how I hear you an opening or a closing down? And if the latter, will I know? And will I know if you shut doors in me so I can make a choice to open them (or not) – or will I never even know that I did not understand you?
And all, all based on who you are and who I am.
The question is: will we ever meet? Will we get a sense of each other as living beings and let each other be moved to respond?
Because in the end that is what matters: contact.
There is no cure for being human other than death. And that is not a cure.
Not any preconceived notions as to where we are going.
There is no one right way to be human: there is only your way, and mine.
And our whole venture is about the experience of being known – and what that means to us human creatures, so made that we are always set apart by this body which is distinct from the rest of the world, yet always wanting to be known in our entirety. So made that we can know of others and know that others know of us – and only know ourselves be known in moments. So made that even though deeply desired we dread these moments – expecting a repeated misapprehension based on our history of being misapprehended and not known.
So that what my history and yours will place into the center of our labors is this dread – yours and mine – that is part and parcel of our knowing of each other. And the more I know myself the more I can know you. The more I can know you the more you can know yourself. For this you do not need the facts of my days on this earth. To the contrary, you need all that I am as unencumbered as possible by those facts – you need me being myself as fully as I can be – and you need me to allow you to use me, to allow myself to be so used by you, even as I strive not to use you in return.
And where, then, can I bring this knowing myself and my not knowing? Where can I tell my story -- including yours as I have heard it, since, having lived that portion of my life hearing you, your story is now part of mine? Where can I bring my inevitable need to use you (as we will all use each other, inexorably) and where my struggle to resist? Who do I tell who will know me and give me back myself more knowable and thence, more known to me? (And of more use to you. And my desire to be used in this way, too, a part of my own story – and now of yours.)
All those who will receive me: lovers, spouse, friends. If I am in analysis myself, also my analyst. Who, being my analyst will not provide me with the full impact of myself on him or her – but with the outlines, yes, the contours of that impact.
And there are colleagues. And if these colleagues should be open to it, I can be – if I am allowed to be –more fully known as analyst to them and thus to me. To them I can tell my story, including content, without the constraints of always trying to use my story to apprehend and give back yours while curbing my own needs and desires – but use (with their consent) the other to apprehend my own.
And in my turn be allowed to do the same for them.
If all goes well, colleagues can provide for each other an environment where we will see more of ourselves. More of what determines who we are and how we are with you. And in so seeing there will be more of me available to see you. And as I see you, you will see more of yourself.
But in the absence of such dialogue, or in the presence of conversations that disapprove and limit and deny, there can be no such exploration and discovery of myself as analyst, and those limits will be part of the limits of who I can know myself to be -- for myself and for you.
So again: the clinical relevance of the autobiographical dialogue.
It is my attempt to be useful to you, the analysand (my wish to be used by you) – and your desire to use me, the analyst (even as, perhaps, you do not dare) that determines the clinical situation.
All true dialogue is deeply autobiographical.
And all true dialogue is relevant to any one of us – is relevant to me, and thus to you.
Because all that I am is relevant to who I will be with and for you.
And who I am with you will determine who you can be with me, and thus, ultimately, for yourself.
And so: all dialogue is clinically relevant.
In the endnotes -- contrary to the text itself where I address myself as a psychoanalyst to my client -- I address myself to my fellow clinicians.
 The title is a variation on and inspired by Louis Sander’s title of 2002: Thinking Differently: Principles of Process in Living Systems and the Specificity of Being Known.
 And this parallels experientially the content of what I am writing of: making contact. And only later explaining myself. Experiencing is always first, it is the process of living. Theorizing is a way of making sense of such experiencing post hoc. It is after the fact, a way of arranging “facts” in a certain order when these “facts” are snapshots in time of a living process, already past. Theory, my colleague Alan Karbelnig would say, is a way of tidying up the mess that is living
 I address myself as a psychoanalyst (therapist,/clinician) to the analysand (client/ patient/ person who comes to see me in my capacity as analyst/therapist/clinician), because in the relating to my clients lies the sole clinical relevance of anything I do or am. It is my positioning myself as analyst vis-à-vis the analysand that creates the analytic situation – the situation in which this particular kind of relating takes place -- in which we are trying to make contact and “make sense together” (Orange 1995:11), in which all that we are and all that we have been is relevant for who we can be together, with the aim of making the analysand more accessible to him- or herself.
 And so it inevitably will. By the end of our work together my clients will know much more of me and in more ways than I will ever be aware of. And this is as it should be.
 This is what I do: my chair is placed vis-à-vis the couch where clients sit or lie as they choose, always able to look at me at will. In light of what we now know of the relevance of feeling ourselves felt by the other by observing our impact on them in their faces, of resonant emotional states created in the perceiver of emotions, it is the only tenable position for me to allow for my being seen and my seeing the other as they (not I) choose. Of course, the visual is not the only pathway to feel oneself felt/ understood. There is the whole body, the voice, and of course what is being said and how. What is imperative is that the analysand find a way to do so. The visual is a highly significant way to which I will not deny my clients access. See also the literature listed in footnotes (9) and (11).
 As much emphasis as psychoanalysis puts on language and the spoken word, the mind-body dichotomy is only apparent. The “talking cure” was never only about talking. “Mind” and “body” are constructs we use to try to understand the whole creature we are. Newest developments in infant research, neuro-psychology, attachment theory and their interface with psychoanalysis bear this out. Minds and brains are two different constructs to look at the whole person – one develops as the other does (or rather, they are not separate) within a relational context. We have tended to disregard the body and its gestures in psychoanalysis – only consider the classical positioning of the analyst out of sight of the analysand – and often that means that the analysand is also out of sight of the analyst. That, too, has an impact, even when (including because) we do not attend to it. See also footnote (5).
 This is the analytic dyad – the crucible where all that will happen in analysis will happen. Where analysis itself – another abstraction from the process of relating of an analyst and an analysand – will take place. The dyad, too, is where our minds and brains (I should say mind-brains or brain-minds, the Winnicottian “psyche-soma”) are built and continue to evolve and change. See Daniel Siegel 1999 and 2003, Alan Schore’s work on Affect Regulation, and D. W. Winnicott’s pioneering understanding of this matter.)
 Webster’s Dictionary: Dialogue: 1. a talking together; conversation 2. interchange and discussion of ideas, especially when open and frank, as in seeking mutual understanding and harmony (italics mine).
 This is what we humans do – orienting towards each other in an attempt to know ourselves even as we know the other. See Beebe and Lachman (2002:36f) in Infant Research and Adult Treatment. Co-constructing Interactions: “(…) perception of emotion in the partner creates a resonant state in the perceiver.” Also Daniel Siegel’s (1999) “The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are.”
 Ideally, and hopefully, I will have more than one of those systems of metaphors available to me (whatever language/s I speak ). James Grotstein spoke of this once in a seminar he was teaching where I was in attendance as “I speak several theories fluently”. But nonetheless, some of these “languages of theory” will resonate with me more than others.
 This process refers to the crucial experiencing for any human being of an other as having one’s mind in mind in order to develop a knowledge of oneself as someone with a mind. Fonagy et al. call this “Affective Mentalization” (Fonagy et al. 2002: Affect Regulation, Mentalization and the Development of the Self). Winnicott refers to it decades earlier (1967) in his paper “Mirror- Role of Mother and Family in Child Development” when he says: “When I look I am seen, so I exist. I can now afford to look and see.” (1967/1971:114). And “What does the baby see when he or she looks at the mother’s face? (…) what the baby sees is himself or herself (…) the mother is looking at the baby and what she looks like is related to what she sees there.” (1967/1971:112).
 “An interpretation is a translation, and what is reflected in an interpretation is the analyst’s personal view of the patient, which is one of many possible realities.” Bromberg (1994: ): “Speak! That I May See You”. Some Reflections on Dissociation, Reality and Psychoanalytic Listening.
 The Berkeley group around Paul Watzlawick and Allan Bateson formulated this understanding in the 1970s with their observation that “we cannot not communicate.”
 Consider the body of work on implicit and explicit memory and ways of knowing (semantic vs. procedural knowledge) -- encompassing so much more than what is or can ever be consciously available to us and which yet colors all that we are and is at the root of all we can never be. Much we can only know about – and never know directly. A number of relevant papers can be found in: Tronick, E. (Issue ed.) (1998): Interventions That Effect Change in Psychotherapy. A Model Based in Infant Research. Infant Mental Health Journal Vol. 19 (3). There among others: Lyons-Ruth, K. (1998): Implicit Relational Knowing: It’s Role in Development and Psychoanalytic Treatment. Also Beebe, B. (1998): A Procedural Theory of Therapeutic Action: Commentary on the Symposium “Interventions that Effect Change in Psychotherapy. Fonagy, P. (1998): Moments of Change in Psychoanalytic Theory: Discussion of a new Theory of Psychic Change. Stern, D. (1998): The Process of Therapeutic Change Involving Implicit Knowledge: Some Implications of Developmental Observations for Adult Psychotherapy. Another, very accessible text integrating a wealth of complex and difficult information on infant research and development into everyday, understandable language is Siegel, D. and Mary Hartzell (2003): Parenting from the Inside Out.
 Language is socially constructed and exists and lives in its usage. It does not fall ready-made from the sky – much as institutions like the French Academy Francaise as well as the German Mannheimer Sprachinstitut may give the impression that language is supposed to be a certain way and not another, what with their efforts to “preserve” what is no thing but a living process in the first place. There are all sorts of determining factors that go into how any of us use language, what any given term and phrase and way of speaking means to us -- all of them socially mediated, in larger (societies and groups and sub-groups) and smaller (families and dyads) ways. However, we are all, as Lacan posits, inescapably born into language. And how we emerge into it, where we emerge into it, with whom we emerge into it will forever color all that we can mean.
 I am thinking of something like Winnicott’s spontaneous gesture here, a spontaneous gesture to each other. A “true self” meeting another “true self” if you will: responding, existing -- and not just reacting to impingement. An analyst/mother providing for the analysand/child an experience/environment that is “good enough”, so that there can be “(…) existing and not (…) reacting.” Winnicott (1960:148). This is a general stance, what it is that is actually needed to be “good enough” will be different for every person coming to see me. “Good enough” is, by definition, less than perfect (and is, paradoxically, exactly what is needed). Here belongs the concept of attunement, including its failure, developed in the idea of rupture and repair. Research shows that moderately contingent attunement (a measure of rupture and repair) is optimal for development (cf. Beebe & Lachman 2002).
 Cf. Louis Sander (2002): Thinking Differently: Principles of Process in Living Systems and the Specificity of Being Known. Also Benjamin, J. (2002): The Rhythm of Recognition. Comments on the Work of Louis Sander, as well as the works referred to in footnote (14). Donna Orange (1995) says: “(…) understanding is incompatible with standing apart.” Martin Buber expresses it thus: “The relationship to the Thou is direct. No system of ideas, no foreknowledge, and no fancy intervene between the I and Though.” (1937:11). And with Orange “(…) subjectivity becomes real only when two subjectivities meet in a personal relation.” (1995:21).
 The Boston Study Group of Change refers to this phenomenon in the treatment setting as “moments of meeting”. In infant research these are moments of affect attunement, including cross-modal ones. Cf. Stern, D. (1985): The Interpersonal World of the Infant, as well as the texts by Beebe and Lachman and Daniel Siegel mentioned in footnotes (9) and (14).
 Here, then, the psychoanalytic concepts: transference and countertransference. Here “nameless dread” and “dread of annihilation”. Here “false self” and “basic fault” and “unthought known”. Here “fantasy” and “phantasy”. Here “defense”, “resistance” and so on. Here also organizing experience around the expectation of a recurrence of previous experience, based on how our actual brains/minds where shaped within early attachment relationships.
 Fonagy et al. (2002) mentioned above in footnote (11) develop these concepts at length within the construct of Affective Mentalization. It is what Winnicott was getting at with his idea of “good enough mothering.” Also, Bion’s beta function belongs here.
 It is again Winnicott (1960) who develops the idea of object usage as an achievement arising out of a “good-enough” mothering situation.
 There are variations here, of course, of relatively more or less transparency. But psychoanalysis as a profession is operating from a stance, by and large, of relative withholding of the analyst’s own explicitly known reality.
 And this is, in the end, what we can do for each other: use each other by mutual consent the way we need to use each other to be more fully ourselves.
 Here again the concept of affective mentalization, i.e. the idea that I can only see what I see being seen. Winnicott’s “When I look I am seen, so I exist. I can now afford to look and see.” (1968/1971:114).
25 I want to make a case here for being careful about where to be so unguarded in public. What I am talking about are personal relationships with other/s who are willing to receive me, will let me have their response and let me respond to them. It is a dialogue with an other/ others I am referring to, a living process. It is not possible to have a personal relationship -- a real dialogue -- with a whole group, only with individuals. For this reason, conferences and large groups are not good places to be so open and vulnerable. What is a chance at being known through contact to an other in a dyad or a small group becomes an experience of exposing oneself in an environment that, because of the sheer number of individuals present, precludes any sustained exchange among any of them. I will not know whether I have been seen – only that I have been looked at (like standing naked in front of a crowd when I want to stand naked in front one other).
Balint, M.(1968), The Basic Fault. London: Tavistock.
Beebe, B. (1998), A Procedural Theory of Therapeutic Action: Commentary on the Symposium “Interventions that Effect Change in Psychotherapy”. IMHJ, 19 (3):333-340.
-------- & Lachmann, F. (2002), Infant Research and Adult Treatment. Co-constructing Interactions. Hillsdale, NJ: Analytic Press.
Benjamin, J. (2002), The Rhythm of Recognition: Comment on the Work of Louis Sander. Psychoanalytic Dialogues, 12 (1):43-54.
Bion, W.R. (1959), Attacks on Linking. IJPA, 40:308-315
Bollas, C. (1987), The Shadow of the Object: Psychoanalysis of the Unthought Known. New York, Columbia Univeristy Press.
Bromberg, P.(1994/1998), “Speak! That I May See You.” Some Reflections on Dissociation, Reality, and Psychoanalytic Listening. In: Standing in the Spaces. Hillsdale, NJ/ London, Analytic Press.
Buber, M. (1937): I and Though. Edinburgh, Scotland, T.& T. Clark.
Fonagy, P. (1998), Moments of Change in Psychoanalytic Theory: Discussion of a New Theory of Psychic Change. IMHJ, 19 (3):346-353.
----------& Gergely, G., Jurist, E. & Target, M. (2002), Affect Regulation, Mentalization, and the Development of the Self. New York: Other Press.
Lyons-Ruth, K. (1998), Implicit Relational Knowing: its Role in Development and Psychoanalytic Treatment. IMHJ, 19 (3):282-289.
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Orange, D. (1995), Emotional Understanding. Studies in Psychoanalytic Epistemology. New Your/ London, Guilford Press.
Sander, L. (2002), Thinking Differently: Principles of Process in Living Systems and the Specificity of Being Known. Psychoanalytic Dialogues, 42 (1):11-42.
Schore, A. (2003): Affect Dysregulation and Disorders of the Self. New York/ London, Norton & Co.
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Siegel, D. (1999), The Developing Mind. How Relationships and the Brain Interact to Shape Who We Are. New York/ London, Guilford Press.
------------ & Hartzell, M. (2003): Parenting from the Inside Out. New York, Tarcher/Penguin.
Stern, D.N. (1985), The Interpersonal World of the Infant: A View from Psychoanalysis and Developmental Psychology. New York: Basic Books.
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Tronick, E.Z. (Issue ed.) (1998): Interventions That Effect Change in Psychotherapy. A Model Based on Infant Research. Infant Mental Health Journal (Special Issue),
---------(1998), Dyadically Expanded States of Consciousness and the Process of Therapeutic Change. IMHJ,19 (3):290-299.
Westen, G. & Gabbard, G. (2001), Developments in Cognitive Neuroscience: 1. Conflict, Compromise, and Connectionism. JAPA 50 (1):53-98.
Winnicott, D.W. (2003, original:1958), Through Paediatrics to Psychoanalysis. London: Karnac Books. (TPP)
--------- (2003, original:1965), The Maturational Process and the Facilitating Environment. London: Karnac Books. (MPFE)
----------- (1999, original:1971), Playing and Reality. London: Routledge. (PAR)
----------- (1949), Mind and its Relation to the Psyche Soma. TPP.
----------- (1956), Primary Maternal Preoccupation. TPP.
----------- (1958), The Capacity to be Alone. MPFE.
----------- (1960), Ego Distortion in Terms of True and False Self. MPFE.
---------- (1967), Mirror-Role of Mother and Family in Child Development. PAR.
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Maxa Ott is a psychoanalyst in private practice in Pasadena, CA, where she is a also a Training and Supervising Analyst at the Newport Psychoanalytic Institute. She holds a Ph.D. from the Southern California Psychoanalytic Institute (now New Center for Psychoanalysis) in Los Angeles, is a licensed Marriage and Family Therapist, and holds an M.A. in both Linguistics and History from the Friedrich Alexander Universitaet Erlangen-Nuernberg in Germany. She is the author of “First Steps in the Clinical Practice of Psychotherapy.” This is Dr. Ott's original publication for her paper "The Clinical Relevance of the Autobiographical Dialogue:Specificity of Knowing and of Being Known".
Dr. Ott may be contacted via email at: firstname.lastname@example.org