PsychBytes

A publication of the Washington Baltimore Center for Psychoanalysis

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Today’s Analyst at Work

J. David Miller, M.D.
Member, Washington Baltimore Center for Psychoanalysis
July 2018 | Volume 5 | Issue 7

When I tell people I’m a psychiatrist, sometimes they ask, “So, are you a Freudian, a Jungian, or a Kleinian?” As an insight-oriented therapist and psychoanalyst, I think we have entered a new era in which such labels no longer fit. Like many of my colleagues, I value several conceptual models, which raises a question: how do I make sense of complex clinical situations without the help of a unified theory?

What works for me is to hold the theories I know in reserve, in the background. Since they are based on empirical evidence, I consider them to be “science,” but I also approach clinical work as an “art,” often relying on intuition, or inspiration. As I listen with open-minded attention, I wait for a clarifying synthesis to emerge, perhaps linked to a theory I hold “on call,” perhaps not. The most useful synthesis often comes unbidden and abruptly, seemingly out of the blue.

The idea that art and analysis both rely on inspiration is a central thesis of Ernst Kris, who was first an art historian and later a renowned psychoanalyst. In his collected essays of the 1930s, Psychoanalytic Explorations in Art, he writes, “wherever art reaches a certain level, inspiration is at work.” Twenty-five years later, in his paper on “Insight in Psychoanalysis,” he states that “the good analytic hour” depends on inspiration, which he describes as follows: “…(it) all begins to make sense…one of the associations has suddenly lifted the veil…associations suddenly ‘converge’…the material comes as if prepared…outside awareness…”

In line with Kris, I find that analytic therapy reaches its potential when both participants open themselves to this preconscious creative process.

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Why does Aref Montazeri, an Iranian sculptor whose art sells for over a million dollars, continue to make his towering works from shards of mirror glass in his studio in Tehran, amid window-shattering bomb blasts? He gently wraps his creations in shock-absorbing material, but why continue with such a fragile medium? In a Wall Street Journal article by Kelly Crow (May 2-3, 2026), he says, “Nothing, not even war, should prevent us from pursuing what we aim for.”

Shortcut

I live in the city and often walk to my preferred destinations. Sometimes my walks include shortcuts when going to familiar places. One common shortcut was an alley which contained rats.

While the rats were disturbing and seemingly everywhere, I continued using my shortcut.  At some point an intervention occurred – poison.  I began to experience the mixed blessing of dying rats instead of living rats.  While I hesitated to look at the dead and decaying rats, they were in my path and I couldn’t ignore them.  In time, the living rats disappeared. But at the end of my alley shortcut, “my inner rats” remained alive in the office of my psychoanalyst.

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