by Velleda C. Ceccoli Ph.D. on March 4, 2013

Ever have the experience of hearing something you said but in a different context? Listening to your words yet feeling like something is not quite right? It may be that the actual words are not quite the same, or that they are said in a different tone of voice or affectation, or tweaked so that they take on a different meaning under the different circumstances. Yep, you have been taken out of context- faced with a reality that was not intended in the first articulation of your words yet, here it is: your words coming back to you and they are not the same, not what you intended. Same but different enough to make you wonder if you actually said that. Out of the particular context in which you first spoke them, they become someone else’s words, taking on their meaning and not yours. Context is everything they say. And they (whoever they are) may be right.

I’ve been thinking about how important the context in which something occurs is, what is said and done, particularly in terms of how something is understood. The more I think about it the more complicated it seems to me. How does context establish itself in our lives? How does it affect and influence how we listen, how we hear and process information, and what we do with it? How does it affect what we say and do?

As usual, when I am walking in the maze of my thoughts, musing about the possibilities of something and finding myself at sea, I sit in my psychoanalytic chair. I fold myself into the space where I spend many hours in contemplation with another. The space where it is necessary to be at ease with not knowing yet continue to think and feel. Context made concrete. My office and my chair provide the context for my ruminations about such matters. So I will start there.

In psychotherapy, context is deeply and inexorably rooted in the relationship between doctor and patient. The language of treatment is relationally embedded. The relationship provides the context(s). How things are said and disclosed, how they are interpreted and perceived, and ultimately how useful what is said can be, depends on what is happening interpersonally between two particular people, and what each of them brings to the interaction at any given moment. This is the context of treatment.

While the boundaries of a situation may provide a contextual outline – in the clinical scenario this involves meeting time, fees, the use of the couch or chair, the person of the analyst, the actual office – it is only an outline, the actual context involves meaning as created and articulated by two people sharing and negotiating their worldview(s). People come to treatment because they are in difficulty and they expect that psychotherapy will offer them an opportunity to address and rectify this. That is the contextual outline of therapy, which then becomes richer through the development of the therapeutic relationship. In other situations, the contextual outline may also involve a work or professional setting, or a particular role or situation. While this contextual outline is established initially by the expectations of a particular situation it is then filled in with the colors and qualities of interpersonal transactions, the multitude of conscious and unconscious interactions that make up relationships.

I think of context as a fluid and porous mega-container that shifts and transforms itself on the basis of relational demands and self-other negotiations. Because context is established relationally it makes sense that much of its texture and feel comes from those explicit and implicit communications that lend an affective aura to situations. For example, I may say or point to something in a session that is upsetting to my patient, at that moment both of us are de-stabilized immediately: my patient because they feel misunderstood or caught out with something difficult, myself because I recognize that I have upset them, or worse, that I have touched on something that because of the way that I said it, or the implicit assumption I might have made about it, may have opened a wound for them. The context in this particular situation is emotionally charged, and what is said and done is flooded with those emotions, informing what happens next. While navigating those situations is something that psychoanalysts are usually adept at, my point here is that affect changes the context, shifting it, often to a historical and personal one, a context that operates under different rules of engagement. Transference and countertransference are contextual phenomena.

Because of this, the context of a situation and/or relationship can determine what the possibilities for growth and reparation are. Even within the therapeutic relationship, where the space is designated as potentially providing for both growth and reparation (providing a contextual outline) such context can shift on its head due to relational entanglements which may be so affectively de-stabilizing to both participants that terra firma is elusive and the power of historical context interferes with here and now interpersonal communication.

Couples often get into a similar tangle. Speak to one partner and they will tell you that they feel unheard, speak to the other partner and they will tell you that they can’t get a word in. Context. In this example both partners are at a stalemate. In order to advance a relational negotiation needs to take place to create a new context, one in which they can both talk and hear each other out. Whether this is possible depends on both partners’ ability to review what they are bringing to the situation (personal context) and how it is being triggered by the others’ actions. It depends on their ability to hold on to who they are, to their context, but not too tightly. It depends on the ability to hold on to who you are while being taken out of context.

Ah yes context. Transference. Countertransference. The relational dance. When I sit with a patient and they remind me of something I said, sometimes I remember it exactly- this is a situation in which both of us agreed and created the context. But just as often, a patient may recall something that I said differently, and has used that interpretation in a way that I had not intended. Taken out of context, my words, intentions and meaning(s) do not feel like they are mine. This situation is one in which my patient and I need to re-examine the dissonance between their understanding and mine, and how it came about. Often what we find is other meanings, voices and even self states have been activated by my words or affectation and its emotional impact on my patient.

Our ability to work and move within multiple contexts, known and unknown, implicit and explicit opens up possibility. This is as true of the therapeutic situation as it is of life. Context is relationally determined. And perhaps this is why we are constantly being taken out of context.

{ 1 comment… read it below or add one }

Erika Schwartz, MD March 6, 2013 at 8:40 AM

As usual, Dr.V puts perspective into context.
I only hope the doctor patient relationship that is lost to modern medicine finds its proper context and by doing so improves outcome.
Thank you for tackling such significant and powerful topics.


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