Chiara S.

The Exit Line: When Patients Speak Last and Leave a Mark The Psychoanalysis of Parting Words

Those last-minute things patients mention as they leave, when there’s no time for a thoughtful response, sometimes leave me frozen or wishing for a time machine to undo a thoughtless reply. More often, though, I’m left wondering what they might mean.

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“The exit line is stated while leaving precisely because the patient wants to keep it out of the session. More exactly, the patient is ambivalent about communicating this material in his sessions. Hurling it up as a parting shot is a compromise between saying it and not saying it.”

- Gabbard (1982)

in an effort to “prepare” their graduates for the realities of 21st-century practice. Unfortunately, course offerings including psychodynamic models that offered a more complete understanding of what it means to enter into the dynamic complexities of a therapeutic.”

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Gianotti, P. (2022).

“Over the past two decades, pressure from managed-care insurance companies to reduce the allotted time for reimbursable mental health treatment has resulted in graduate schools shifting their curricula to short-term treatment models ...

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“Feeling stuck in psychotherapy is actually the place of opportunity. Stuck is where our patient has been living before she met us, or else she would not have made her first appointment. The difference is this time she and we are arriving at her place of stuck together.”

- Peebles, M.J. (2022).

“Psychotherapy grows a sense of value and contentment that we can generate internally. Our well-being becomes less dependent on external circumstances over which we have lessening control.”

- Peebles, M.J. (2022).

Peebles (2022) on how change—in psychotherapy—takes time.

“The quandary is that the patient arriving for her first session, the one who is intuitively seeking for her Monday-maps to change, is also likely, given our culture, expecting this change to happen fast.”

“The place where we don’t-know, and feel stuck in the therapeutic process, is often the place that holds the nub of why our patients came to see us.”

- Peebles, M.J. (2022).

“Discussions in classrooms could not explain what it would feel like to sit in a room with someone who wanted, and at the same time did not want, to be there with me.”

- Peebles, M.J. (2022).

The papers I vowed to read over the summer.

I’m in full denial that summer is over, and I’ll definitely finish the pile of papers and books before summer ends.

“CBT is not without virtue, and in a sense the problem is not with CBT itself, (…). Problems became apparent when CBT’s ambitions expanded to colonize all forms of psychological suffering.”

- Dalal, F. (2018).

- Dalal, F. (2018). CBT: The Cognitive Behavioural Tsunami. Managerialism, Politics, and the Corruption of Science.

“As things stand today, in order for something to count, it must be countable. But further, and more worryingly, in some contexts the number itself becomes more real than the thing it is apparently representing, some much so that in some instances the numbers become the reality.”

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“Psychoanalytically, Bion suggests, the royal road to O is through the analyst’s suspension of memory, desire, and understanding. Since memory focuses on a past that is already gone and desire on a future that does not yet exist, one is left only with the present.”

- Reiner, A. (2023).

These unconscious lies are a mode of ‘thinking’ that is not thinking, using ‘words’ that are not really words, for they are not being used to communicate but to obstruct communication.”

- Reiner, A. (2023).

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“Bion’s ideas about lies are also among his most useful ideas in understanding mental functioning. We may see patients who function at a high level but whose primary mode of mental functioning is a lie.

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“Apropos of Bion’s (1962) early idea that thinking develops ‘as a method or apparatus for dealing with thoughts’, many writers say that they don’t write to express what they think, but rather to find out what they think, as their unthought thoughts are revealed to them.”

- Reiner, A. (2023).

“To hear the selected fact requires the intuitive waking dream state of the unknowable O, which starts with our having the faith and courage to face our own ignorance, to stop thinking about what we know so we can focus on learning what we don’t know.”

- Reiner, A. (2023).

“Bion adds that if one can suffer pain one can also ‘suffer’ pleasure, so the real issue isn’t pleasure or pain but the capacity for a mind able to tolerate the reality of feeling.”

- Reiner, A. (2023).

“How does one address an absent self when the false self knows nothing of the true self or its needs?”

- Reiner, A. (2023).

“Silence has an important role in analysis, for one has to take time to feel, and think, and keep observing without preconceived ideas, in order to detect the underlying meaning of a session.”

- Reiner, A. (2023).

“Some people may be frightened of Bion’s ideas without recognising that what is actually feared is the uncertainty of a vast, unknowable human mind beyond our control.”

- Reiner, A. (2023).

“His [Bion’s] tendency to leave space for people to think for themselves seemed evasive to some, or purposefully confusing, and others wondered if he was psychotic.”

- Reiner, A. (2023).

“A rigid allegiance to one or the other type of analytic thinking can narrow the way one listens to the patient. Worse, it can lead to a situation where the analyst does not listen at all because his theory offers him a prepackaged and formulaic understanding.”

- Akhtar, S. (2012).

“The relevance of silence to psychoanalysis becomes unmistakably clear when one takes into account that silence between two (or more) human beings can signify a vast range of feelings and psychic configurations.”

- Akhtar, S. (2012).

“Analytic listening, for Freud, was not restricted to the patient’s spoken words. It also included paying attention to his silences, and to the non-verbal cues he offered. Attention of such breadth required a relaxed submission to all the input that was coming one’s way.”

- Akhtar, S. (2012).

Can we just skip to that part right away? That sounds fun.