Evocativeness: Moving and Persuasive Interventions in Psychotherapy (Book Review)

Author:  Appelbaum, Stephen A.
Publisher:  Northvale, NJ: Jason Aronson, 2000
Reviewed By:  Marilyn Metzl, Summer 2002, pp. 47-49

Evocativeness was Dr. Stephen Appelbaum’s final book before his untimely death. Dr. Appelbaum, a psychoanalyst in private practice, had an illustrious and prolific career at the Menninger Clinic in Topeka, the University of Missouri School of Medicine, the Austin Riggs Center in Stockbridge, Massachusetts, the Department of Psychiatry at Harvard Medical School, the Boston Psychoanalytic Institute and Massachusetts Institute of Psychoanalysis, and, most recently, the Southeast Florida Institute of Psychoanalysis. He was the author of six books, on the editorial board of ten journals and won four writing awards.

Evocativeness yields varying levels of therapeutic learning, depending upon what the reader brings to the experience. Appelbaum looks back over sessions with a variety of patients and presents illustrations of clinical material of both successfully “evocative” interventions and those that he considers “uninspired.” The first section of the book presents evocativeness in theoretical and definitional terms. In the second section of the book, Appelbaum offers transcripts of clinical sessions and analyzes these transcripts in terms of the therapist’s successful and sometimes less successful use of evocative interventions. This intriguing journey into the consulting room allows us to share in his therapy sessions and act as both investigator, supervisor; critic and psychoanalyst. This viewing allows us to be voyeurs into his therapy sessions and to second-guess our own steps as we think about these interpretations and match them to our own rendering of what we would have done, given the same material.

Broadly speaking, Applebaum’s notion of the evocative is a strategy for understanding a host of clinical interactions, and ultimately for improving interventions. Appelbaum asks therapists to experience therapy through an expanded self-awareness, and warns against an over-reliance on interpretation. As such, the author repeatedly connects looking at art and performing psychotherapy, thereby distinguishing thoughtful practitioners from those who “play to the second balcony, cranking out or struggling to find utterances worthy of quotation and speaking dramatic language whenever possible” (p. 45). Similar vitriol describes the therapist who “manipulates” patients into a particular form of behavior or pattern of thought (p. 48).

Conversely, Appelbaum’s evocative therapist does not use the artful playing of roles in order to enable the patient to merely re-enact old scenarios in a new way (although he indicates that corrective emotional experiences are often useful). Utilizing the contemporary, analytic schema of a two-person therapy, Appelbaum insists that the evocative therapist discovers within himself the roles that will open the way toward healing insights. In order to do this, the “evocative therapist” must be practiced in experiencing a flexible range of responses and interventions, just as a gymnast or a skater must train and exercise for years in order to master his/her art. According to Appelbaum, the evocative therapist realizes the futility of a one-size-fits-all approach. Each patient is different and each patient evokes from the therapist the potential that both therapist and patient are capable. Evocativeness requires the confidence, surefootedness, and skill of a therapist who is comfortable within him or herself and who is not afraid to be bold and to utilize Appelbaum’s suggestions. There is no place in his consulting room for a “talking head.” Intellectualization and isolation of affect are seen as a form of resistance, and evocativeness is a tool used to inject color in order to help bring the “unaware into awareness,” a step that is usually required by most patients, particularly those with strong inhibitions who are not in touch with their emotional life.

According to the author, evocativeness brings a sense of energy and novelty into the therapy session. In Chapter 1, he states that the injunction is to avoid tried interpretations such as “you are feeling guilty” or “you are feeling shame,” and to allow something “uncontrolled” to go on during the therapy session, so that a new vision of life emerges. Just as certain works of art move others and us do not, therapists have differing emotional responses to psychotherapeutic sessions. In some sessions, feelings and ideas are powerfully communicated and experienced, so that the patient can feel pride and experience joy, feelings, which are mirrored by the therapist. Conversely, in some sessions, both therapist and patient are bored and distracted, and “having lunch” is the main thing on their mind.

Appelbaum presents an inspiring model of “Listening with the Third Ear,” (p.10) taken from Theodore Reik’s famous book of the same name, to present a caution to differentiate between manifest content and the transmission of information by the second voice (thus allowing the patient and therapist to understand and make the patients experience vivid and lively). In psychotherapy, the first voice can be considered the transmission of meaning, listened to and interpreted by the “third ear.” This process involves the ferreting out of latent content to yield insight. The “excellent” therapist is skilled at uncovering and analyzing the hidden meanings that lie behind manifest content. This communication is reminiscent of Knoblach, (2000) who discusses the importance of noting rhythm, cadence, and breath as means of communicating with the patient’s unconscious. Knoblach compares the patient’s communication to music, in which it is as important to attend to the shading, starts and stops, to the forte and pianissimo, as it is to the melody. Appelbaum, like Knoblach and Freud, has undertaken the challenges of teaching us to always ask “why.” The answer to this question, through evocative interventions, brings forth hidden meaning into “useful emotional awareness.” Freud (1933) recognized the difference between intellectual and emotional understanding. In Chapter 8, Appelbaum discusses Freud’s analytic terrain, and analyzes it from the standpoint of evocativeness out of a deep sense of history. Freud was evocative in his manner, his choice of office furnishings and in his choice and delivery of words (p.95). A brief review of Freud’s famous cases, Fraulein Anne O, Frau Emma Von N., Miss Lucy R., Katherine, Frau Elizabeth Von R., Dora, The Rat Man and The Wolf Man, presented Freud’s sensitivity to each patient’s individual needs, but demonstrated how the interventions were sometimes intrusive as Freud yielded to his impulse to action rather than trusting the analytic relationship (p.106).

The evocative therapist is encouraged to develop empathy in the truest sense of the word, so that he or she can personally represent what the patient is feeling without having to experience the same trauma. An example given in this book is an actor’s ability to play the role of Hitler by studying and by drawing upon the actor’s usually latent megalomania and sadism without having literally designed a plan for world conquest and systematic murder (p.51). The therapist is encouraged to empathize with states that he has not experienced, and to discover the latent qualities in him or herself that would help him respond with the most helpful and effective self-presentation. Not only can imagination substitute for reality, but, according to Appelbaum, sometimes substitution can improve upon reality. The self of the patient and the therapist is then drawn by evocativeness into awareness and experience and, as a result, become more vital and alive. Caution is given to go beyond developing therapeutic skills and beyond learning the facts of a person’s life, but to take this information and transform it in order to communicate this understanding evocatively. This skillful art is repeatedly contrasted with “wild” analysis, where emotions are expressed primarily for catharsis with the elucidations invoked by evocativeness, but the goal being expression rather than deepened understanding.

I felt a sense of exhilaration as I read this book. Evocativeness means, “calling out; summoning forth, as from delusion or from the grave,” and Appelbaum has admirably done just that. His spirit has communicated across time and space, evoking what Lionel Trilling (1955) said about Freud’s view of the mind: a poetry making faculty, and much of life is determined by the organisms’ need to keep anxiety at a tolerable level: a level high enough to motivate and low enough so as not to be overwhelming and excessively painful.

In posing the question of whether evocativeness can be learned, the answer given in Chapter 6, is that our potential is determined both by whom we are and with whom we choose to learn. According to Appelbaum, some people are by nature evocative, while others, through no fault of their own, although not hopeless require systematic training. Models presented for this training include demonstrations by a supervisor of an actual intervention and developing the supervisee’s awareness of a wide range of possible interventions ranging from ordinary to evocative. In illuminating the importance of awareness of a single change in word, choice, tone or inflection, the supervisee is sensitized to the subtle differences available.

As always, Appelbaum is challenging, never dull, and his legacy to us is to attempt to challenge our own conventional thinking and to step out to the edge without falling off. During all of the years that I knew him, he was always evocative, and this book is a legacy to his unusual and creative way of looking at the world that was evident throughout his long and productive career. “Few if any activities benefit from going unquestioned. Not only is the good the enemy of the best, but the bad has its way when the atmosphere is one of complacency, with consequent inertia.” Thank you, Dr. Stephen Appelbaum. You are sorely missed.

References

Appelbaum, S (1992), Evils in the private practice of psychotherapy. Bulletin of the Menninger Clinic, 56, 141-149.
Freud, S. (1933), New introductory lectures on psychoanalysis. Standard Edition 22.
Knoblauch, S. (2000), The musical edge of therapeutic dialogue, Hillsdale, NJ: Analytic Press.
Reik, T. (1951) Listening with the third ear. New York, NY: Doubleday.
Trilling, L. (1955) Freud and the crisis of our culture. Boston, MA: Beacon Press.

Reviewer Note

Marilyn N. Metzl, Ph.D. is president of Section IV of Division 39 and a psychoanalyst in private practice. She is a training analyst with the Kansas City Institute for Contemporary Psychoanalysis.

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