Freud And The Divided Brain: The Therapy Of Attention
This article was written by Rod Tweedy.
Attention and Psychotherapy
Central to McGilchrist’s exploration of the difference between the hemispheres is the notion of attention. As he suggests, “attention is not just another ‘function’ alongside other cognitive functions”. Rather, the kind of attention we bring to bear on the world actually alters the nature of the world we attend to: “Attention changes what kind of a thing comes into being for us: in that way it changes the world” (2009, p. 28).
Each hemisphere delivers and indeed embodies a distinct form of attention. As McGilchrist observes,“each hemisphere attends to the world in a different way—and the ways are consistent” (ibid., p. 27). Briefly put, the left hemisphere of the brain specialises in a narrow, focussed form of attention, ideal for honing in on whatever it has decided to focus on and analyse, whereas the right hemisphere delivers a completely different – indeed “incompatible” – mode of attention that is open, broad, vigilant, and receptive to the other – whatever that other may be. As McGilchrist summarises it, “the right hemisphere underwrites breadth and flexibility of attention, where the left hemisphere brings to bear focussed attention” (ibid., p. 27). The need to keep these two distinct and mutually incompatible forms of attention separate seems to underlie the very reason for the brain being divided in the first place, as McGilchrist has compelling shown (ibid., p. 27).
The “open, vigilant, broad, contextual form of attention” that McGilchrist characterises as the right hemispheric mode is of particular significance to Freudian psychoanalysis, as it is exactly the mode of attention that Freud himself claimed lay at the centre of the practice. As psychotherapist Robert Snell has shown in his fascinating study, Uncertainties, Mysteries, Doubts: Romanticism and the analytic attitude (2013), “this undirected but somehow actively receptive state of mind” is of “central importance in psychotherapy” and is “generally referred to, conveniently but far too concretely, as the ‘analytic attitude’:
Freud called it ‘free-floating’ or ‘evenly suspended attention’ … It is a kind of ‘free’ listening, the counterpart to the free association that psychoanalysts encourage in their patients, through which the unconscious, like contraband in the ordinary unchecked stream of thought, might have a chance of declaring itself. It is an emotional orientation in the therapist, a commitment, founded in respect, to maintaining a radically open-minded stance: a suspended state somewhere between passivity and readiness for emotional and verbal activity. (Snell, 2013, p. 1)
Freud’s “evenly suspended attention” correlates with the radically open-minded stance that McGilchrist identifies as the right hemisphere form of attention. As Schore notes, “Freud’s concept of the state of receptive readiness as ‘evenly suspended attention’ can also be identified as a function of the right hemisphere, which uses an expansive broad attention mechanism that focuses on global features (as opposed to the left that narrowly focuses on local detail)” (Schore, 2011, p. 84).
Freud made the recognition of this state central to his technique. Indeed, he calls cultivating this mode of attention “the fundamental rule of psychoanalysis”, and in his classic paper ‘Recommendations to Physicians Practising Psycho-analysis’ (Freud, 1912e), he formulates it in terms of the requirement on the analyst’s part to maintain exactly this type of “evenly distributed”, “suspended”, “hovering”, “circling” or “free-floating attention”:
The technique … consists simply in not directing one’s notice to anything in particular and in maintaining the same ‘evenly suspended attention’ (as I have called it) in the face of all one hears … as soon as anyone deliberately concentrates his attention to a certain degree, he begins to select from the material before him; one point will be fixed in his mind with particular clearness and some other will be correspondingly disregarded, and in making this selection he will be following his expectations or inclinations. This, however, is precisely what must not be done. In making the selection, if he follows his expectations he is in danger of never finding anything but what he already knows; and if he follows his inclinations he will certainly falsify what he may perceive. (Freud, 1912e, pp. 111-112)
Two things are striking about this passage: the first of course is Freud’s attention to attention: the way he places it at the very heart of his whole work (“The technique … consists simply in not directing one’s notice to anything in particular and in maintaining the same ‘evenly suspended attention’…”). The second is his registering of two distinct types of attention that can occur – one a selective, fixed, judgemental mode (“as soon as anyone deliberately concentrates his attention to a certain degree, he begins to select from the material before him”) and the other a much freer, more expansive mode – one that seems open both to the unconscious and to a much wider and deeper mode of relationship and awareness. He notes that the analyst must encourage the latter mode in order for treatment to be successful, and to strongly discourage the narrower, pre-selective mode, which already knows what it wants to find (“This, however, is precisely what must not be done”). These are the right and the left modes, respectively, and Freud places them at the centre of his practice.
In his ‘Recommendations to Physicians Practising Psycho-analysis’, Freud is talking about the importance of cultivating this openly-directed mode of attention in the analyst. But he also, strikingly, argues that a similar, radically open-minded stance must be encouraged in the patient as well, in order to stimulate the unconscious processes of free association and therapeutic receptivity:
It will be seen that the rule of giving equal notice to everything is the necessary counterpart to the demand made on the patient that he should communicate everything that occurs to him without criticism or selection. If the doctor behaves otherwise, he is throwing away most of the advantage which results from the patient’s obeying the “fundamental rule of psychoanalysis”. The rule for the doctor may be expressed: “He should withhold all conscious influences from his capacity to attend, and give himself over completely to his “unconscious memory”. Or, to put it purely in terms of technique: “He should simply listen, and not bother about whether he is keeping anything in mind.” What is achieved in this manner will be sufficient for all requirements during the treatment. (Freud, 1912e, p. 112)
Rather remarkably, Freud perceptively saw in 1912 that the secret of psychoanalysis lay in directly engaging what we today recognise as right hemispheric processes, and he also discovered a way to do this – the mechanism of “free association”.
Freud’s formulations were to have an enduring impact on all subsequent psychoanalytic practice, from Ferenczi’s understanding of the importance of engaged “witnessing” (“it appears that patients cannot believe that an event took place, or cannot fully believe it, if the analyst, as the sole witness of the events persists in his cool, unemotional and… purely intellectual attitude”, Ferenczi, 1995, p. 24), to Bion’s recognition of the importance of “reverie” in the therapeutic alliance, and Grotstein’s recent formulations regarding “right-hemispheric listening” and “right hemispheric processing” during the analytic session (Grotstein, 2009, p. 31, p. 37), the nature of therapeutic attention is key to unlocking both the unconscious and the transformative mechanisms of therapeutic change.
Grotstein remarks that “Freud apparently never realised that he had, in effect, discovered the functioning of the right cerebral hemisphere!”, but in fact, both in terms of his cultivation of free association and evenly suspended attention, and through his introduction of the couch as a means to further engage and facilitate these processes, he seems to have been a remarkably perceptive and pioneering practitioner in this. Thus, the origins of the famous analytic couch seems to have been directly linked to facilitating right hemispheric processes: “this ‘right-brain’ shift in the lying-down position in analysis”, notes Grotstein, “would be demonstrated by the nature of the patient’s associations, which would be ‘free’ – that is, optimally disconnected from ‘left-brain’ editing, censorship, and control – and would instead be organised by the unconscious” (ibid., pp. 13-14). That these ‘free’ associations were emanating from the patient’s right hemisphere is further corroborated by the recent research of Grabner, Fink, and Neubauer, who note that “the right hemisphere operates in a more free-associative, primary process manner, typically observed in states such as dreaming or reverie” (Grabner, Fink, & Neubauer, 2007, p. 228) – exactly the sort of state that Freud sought to develop and encourage.
Freud’s understanding of the peculiarly compelling nature of attention, and how it lies at the heart of therapeutic practice, is one of his most prescient discoveries. “Attention is an unbelievably powerful force”, Jordan Peterson observes: “You see this is psychotherapy, too, because a lot of what you do – and in any reparative relationship – is really pay attention to the other person. Pay attention and listen. You would not believe what people will tell you or reveal to you if you watch them as if you want to know, instead of watching them so that you’ll have your prejudices reinforced” (Peterson, 2017). The key to therapy, or indeed to any kind of “reparative relationship”, he therefore notes, is “more consciousness, it’s more attention”, and this increase in attention operates and acts in therapy both through the analyst and the analysand.
The talking cure works not so much because someone is talking, but because somebody is actually, truly, listening – truly paying attention to them. And that act, Adam Philips observes, is revelatory: something changes, something shifts. “The power of being listened to”, he notes, “is extraordinary”:
Being listened to, and being with somebody who takes genuine pleasure in listening, is really powerful. It really has an effect. And it seems to me – and it isn’t a ‘cure’, but if it was a ‘cure’ – it’s a listening cure, not a talking cure. And it’s amazing what people will say if they think they’re being listened to. (Phillips, 2015)
This quality of attention is one of the great secrets of psychoanalysis, as indeed it is of all our relationships. We are, sadly, so used to people attending to us in the left brain way – an essentially egoic, self-enclosed, instrumental way (McGilchrist, 2009, pp. 392–393, p. 403). When someone actually turns on the full force of the right-hemispheric mode of attention – which wants nothing, which simply engages and listens, and cares – then extraordinary things happen.
On a neurological level, the way we direct our attention actually alters the brain, as Siegel and Siegel strikingly note: “What we pay attention to and how we pay attention shapes the flow of energy and information within our bodies and relationships”, and a shift in attention therefore has the ability to radically transform states:
Attention is the process that directs this flow of energy and information both within the body and between people … what we pay attention to changes the function and structure of the brain. A shift in attention has the ability to radically transform states from chaos or rigidity to integrative functioning, as when sensing the body calms the mind, or naming an emotion tames distress. Where attention goes, neural firing flows, and neural connection grows. (Siegel and Siegel, 2020, p. 143, p. 139)
Where attention goes, neuronal firing flows – this goes to the heart of the power of attention, and to the crucial issue of which mode of attention we choose to employ, and when. The way we direct our attention is the underlying change mechanism of both psychoanalysis and mindfulness: as Kabat-Zinn notes: “mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn, 1994, p. 4). “This kind of attention nurtures greater awareness, clarity, and acceptance of present-moment reality” (ibid., p. 4).
Many of the key figures in the history of psychoanalysis and psychotherapy have noted the radical and transformative changes that altering our mode of attention brings. From Freud’s and Ferenczi’s observations of its reparative effects in individual therapy, to its central role in modern forms of group therapy and systems-centred therapy, body psychotherapy and relational psychology, and gestalt and existential therapy, attention holds a vital and fundamental place, and our ability to shift forms of attention occupies a crucial role in many reparative and reintegrative practices (Tweedy, 2020). EMDR therapy, for example, is a particularly striking instance of how shifts in bilateral attention can produce significant cognitive and affective alterations. Encouraging the patient to ‘just notice’ (pay attention to) certain bodily sensations and to shift attention from the left to the right side of the body, can facilitate significant flow and movement within the mind and body: as Mollon notes, “the act of directing attention to the sensation, while continuing the eye movements or other bilateral stimulation, tends to bring about a bodily change, usually in the direction of reduction of physiological agitation” (Mollon, 2005, p. 2).
It was the remarkable achievement of McGilchrist to reveal how these two distinct forms of attention correlate with the two hemispheres of the brain, which underwrite, embody, and deliver them. “Attention may sound a bit boring,” notes McGilchrist – who has perhaps done more than anyone to draw our attention to our attention – “but it isn’t at all”:
The kind of attention we bring to bear on the world actually alters the nature of the world we attend to … Attention changes what kind of a thing comes into being for us: in that way it changes the world. (McGilchrist, 2018, p. 13; McGilchrist, 2009, p. 28)
Attention “changes the world”: this recognition of the peculiar nature of attention, and the realisation of the availability of two distinct modes of attention, each bringing into being a different sort of world, is I think the key element in the new understanding of hemispheric difference and its importance to psychotherapy. Therapy is all about relationship, and as McGilchrist notes, attention underwrites relationship: it both directs and determines our sense of relationship with the world – to what we pay attention to, and therefore to what kind of relationships we find ourselves in. “What we pay attention to and how we pay attention shapes the flow of energy and information within our bodies and relationships”, note Siegel and Siegel: “a shift in attention has the ability to radically transform states from chaos or rigidity to integrative functioning, as when sensing the body calms the mind, or naming an emotion tames distress” (op cit., p. 144).
Perhaps we should not be so surprised at the power of directed attention, or its central role in therapy. Attention, as we have seen, is the very basis of our relationship to the world, and how we are attended to, and how we in turn attend to others, profoundly shapes our experience of that world. That ‘attention’ should play such a prominent role in modern therapy seems apt: as the Jungian analyst James Hillman once observed, the very term therapeutes – the origin of our modern word “therapist” – means “one who attends”, and in classical times, what the therapeutes attended to was both “the Gods” and “the sickness”. Indeed, in some senses, he suggests, they are perhaps the same (Hillman, 1975, p. 192).
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- Tweedy, R. (Ed.) (2020). The Divided Therapist: Hemispheric Difference and Contemporary Psychotherapy. London and New York: Routledge.