For one can always start something new: An Arendtian-psychoanalytic reflection on patient agency.

Abstract

In this study, we explore the etymology and history of "agency," link it with relational psychoanalytic literature, and examine how it can be understood within Lacanian psychoanalytic theory and practice. Building on its history, we find that "agency" embodies a binary distinction between the person as an actor, on the one hand, and as a being who is subject to determining structures, on the other. This binary approach, however, limits the debate concerning agency. Arendt's concept of "action," which builds on the same etymological stem as "agency" (i.e., "agere"), allows for nuance in the concept and moves it beyond its otherwise binary understanding. Through this conceptual work, we draw three conclusions regarding patient agency: (a) agency can only come about in relation to others; (b) initiating a new beginning in speech acts and actions already implies agency; and (c) one must be willing to take responsibility for the consequences of one's actions to be able to feel agentic. Lastly, we relate these three conclusions to Lacanian psychoanalysis, in particular to the notions of alienation and separation, full speech, and guilt.

A Multi‐layered Approach to Patient Agency: Applying the Listening Guide to a Patient's Narratives

“…Yet, also in ‘the inexplicable’, we notice a shift: post‐treatment, Laura is able to elaborate a bit more on her mourning compared with the pre‐ and peri‐interview. With regard to agency, we might state that, as long as some experiences and/or themes are not symbolized, a person is predominantly situated in a passive position, unable to relate differently to the theme and, by extension, to act in an agentic manner (see infra; Acke & Meganck, 2022; Fink, 2010).…”

“…Moreover, a patient can never be 'complete' or 'fully agentic' (Acke & Meganck, 2022). As becomes clear in the case of Laura, the whims of everyday life thwart agency.…”

“…Aligning with Fink (2010), we do not necessarily expect the ‘understanding’ of these events to cause change (in agency) but rather the act of ‘bring[ing] them to speech’ (p. 271). As such, the search for language and the creation of narratives is considered a prerequisite for taking matters into one's own hands and acting upon the situation (Acke & Meganck, 2022). In this sense, agency might manifest itself as the manifestation of full speech that introduces something new and thereby changes the subject who speaks (Lacan, 1991).…”

“…Even though psychoanalytic thought shuns the idea of self‐conscious agency belonging to a unitary ‘I’, considering the patient as an agent of change is essential for clinical practice (Frie, 2002; Acke & Meganck, 2022). Yet, the discussion concerning agency and the postmodern notion of a multiplicity of stories remains merely theoretical (see, for instance, Benjamin, 2018; Frie & Reis, 2005; Frederickson, 2005; Gentile & Macrone, 2016).…”

Agency via speech: A Lacanian perspective on the process toward agency in psychoanalytic therapy.

“…Yet, the agency we are aiming at is of a different nature than Gorlin and Békés’ (2021) definition which seems to be in line with the idea of a more or less conscious self that considers its intentions and converts them into action (possibilities). In an earlier conceptual article, we described how agency is often approached in a binary manner, either ascribing agency to an “omnipotent Cartesian subject that single-handedly creates its own experience” (Frie & Reis, 2005, p. 28) or considering it as an illusion of the ego (Acke & Meganck, 2022). Roughly speaking, we could consider Gorlin and Békés’s (2021) approach as largely compatible with the former proposition, whereas the early teachings of Lacan—approaching the subject as determined by language—could be considered compatible with the latter.…”