which interdependence underpins each of these, including a short commentary on
how compassion develops in such circumstances.
The core process of transformation in the long-term psychodynamic therapeutic
relationship includes encountering difficult feelings, desires, and impulses, and
investigating their origins and meanings with the therapist. Some of this takes place
in the transference of sexual, aggressive, or other frightening feelings experienced as
being caused by, or reactive to, the therapist. The effective therapist provides a gentle
matter-of-fact attention (often called ‘bare attention’ or ‘neutrality’) that encourages
the patient to explore such states, even though both patient and therapist may be
somewhat self-conscious or uncomfortable. Both patient and therapist are initially
ambivalent about such stressful encounters involving the transference, but in the
course of therapy they come to feel deeply grateful, even freely creative, in their ability
to explore together the patient’s most difficult feelings and impulses within the
transference, as well as in regard to other people in the patient’s life.
Long-term psychotherapy achieves the transformation of suffering by leaving
certain kinds of things unsaid—for example, most if not all of the therapist’s hostile,
erotic, aggressive, or hateful feelings towards the patient—while putting other things
into words. The therapist’s interpretation of unconscious meaning is one of the
methods of achieving insight into the patient’s troubling emotional habits. The
therapist will use words, phrases, sentences, and gestures to communicate emotional
meanings for what may have been unknown or hidden from the patient’s awareness,
but has been repeatedly implied or unknowingly expressed to the therapist. For
instance, the patient may have frequently said to the therapist, ‘I believe you are
critical and judgmental of me’ just when the patient is unconsciously feeling that way
towards the therapist. The response to this type of projection of affect may be anything
from a silent noting by the therapist that she or he does not in fact feel this way to
saying openly something like ‘Perhaps you are feeling this way about me at the
moment?’ or something similar. Over the development of a successful long-term
treatment, such inquiry becomes quite ordinary. It is an opening to explore a whole
context or narrative surrounding the patient’s feelings (or occasionally the therapist’s
feelings) that will inevitably connect to the patient’s troubling habits of mind
(assumptions and emotional dynamics) that are at the root of a lot of her or his
suffering.
Other therapeutic interpretations may respond to a patient’s reports of daily life,
silences, gestures, claims to truth, postures, and night-dreams. A therapist’s ability to
be truly helpful in making interpretations, that are not humiliating or belittling of
the patient, depends on the therapist’s training, expertise, self-awareness, and
confidence in relying on the therapeutic relationship for the discovery of meaning.
Within this relationship, patient and therapist are also two ordinary human beings
who are working together to try to bring about the alleviation of suffering in at least
one (the patient), and more profoundly in both. The patient has hired the therapist
to do a job that the therapist has been trained to do. The therapist, like any other
trained professional, will be more or less able to perform satisfactorily on a particular
occasion, relevant to the therapist’s state of mind and many other factors. The periodic
THE TRANSFORMATION OF HUMAN SUFFERING 73