Sunday, January 25, 2015

Film today: The Sixth Sense

The 2014-2015 Film Series of The Tampa Bay Institute for Psychoanalytic Studies, Inc (T-BIPS) and The Tampa Bay Psychoanalytic Society presents today the M. Night Shyamalan film, The Sixth Sense, starring Bruce Willis as a child psychologist Dr. Crow and Haley Joel Osment as his disturbed patient, Cole. And what ails Cole the most? Like so many gifted children in a disturbed world of family ghosts, he sees what no one else can bear to see.

That parents in many families unwittingly reveal their torments –having dissociated or repressed their own past traumas of chronic misrecognition; attacks on their reality; or physical, emotional, and sexual abuse— inadvertently leads to terrifying consequences for their children and themselves. It is not only the ghosts of Shyamalan’s film who are lost souls, but all of us who cannot face our own trauma, including our inevitable finitude. Our wish not to see what Cole sees, along with our collective denial of death, allows the audience to believe that Dr. Crow must be alive after having been shot a year earlier. This despite that crows, of course, were well known to have been long associated with death, or its harbinger. The crow has also been attributed powers as a spirit guide, with the powers of sight and transformation.

It is Dr. Crow who must lead lost souls, both living and dead, to some form of grace. The ghosts are tormented by their self deception— they do not know they are dead. Cole, like the gifted child in a family haunted by the ghosts of past trauma, struggles valiantly to face that which he also wishes to avoid (seeing the torment of others). Ironically, perhaps inevitably, it is the healer himself who cannot face his own truth—for we are all wounded healers—and Cole can only be helped to face, to listen to, the ghosts as he helps Dr. Cole face his own plight.  The wisdom in Cole is his gentleness in revealing what he intuitively understands is too painful for Dr. Cole to see.

[Is it an ethical dilemma for the therapist to be blind about one’s self (and only on the road to healing) while simultaneously attempting to heal patients? Is it incumbent upon the therapist to be set free by one’s own truth before ever attempting to help others? Perhaps Cole and Crow were both lucky to have encountered one another, despite the pain engendered on their way to a second chance.] 

Friday, January 16, 2015

Depression is Us

Bromberg, who has written cogently on the patient’s need to stay the same (not give up a part of himself or lose a sense of who he is) while changing, cautions the analyst against attempts to alleviate a patient’s depression without first respecting that depression is not merely an affective state but is also who the patient is: “For many people [depression] is a self-state with its own narrative, its own memory configuration, its own perceptual reality, and its own style of relatedness to others.” Because the patient has a need to preserve the self and self meaning, he cannot easily allow the analyst to destroy a part of his personal reality as if it is meaningless.

By giving in to a patient’s demands in an effort to relieve him of his depression the analyst attacks the patient’s self and speaks to the analyst’s incapacity to bear with him his suffering. Gratification of patient’s needs (in attempts, for example, to relieve depression) can become “a form of misrecognition, …evidence to the patient that the analyst is unable or unwilling to authentically ‘live with’ the patient’s state of mind.” While “patients in general need soul-searching emotional openness from their analysts” the analyst’s inauthenticity makes it difficult for her to give the patient what is actually needed—genuine mutuality— and so the patient understandably responds by pushing the analyst “to the edge” in the hope of helping her change into someone more capable of genuine mutuality.


Tuesday, January 6, 2015

Body sensations as the precursor to thought

Patients with psychosomatic disorders have been variously conceived as lacking in symbolization, being alexithymic (without words for emotions), and having deficits in mentalization. Lombardi’s paper is reminiscent of our discussions in the Repetitive Painful States course about symbolic origins, or lack thereof, and the development of (bodily) experience into “the differentiating force of thought.” According to Lombardi, the body is the starting point for mental activity, and upon it psychic reality is based. “[T]he body furnishes the constitutive elements from which are derived both the precursors of the emotions and the perceptual structure out of which the ego develops.” Without an internal construct, internalization is meaningless.

Furthermore, “[T]he sensory level imposes itself as the sole condition for gaining access to existence.” Through bodily sensations (such as the smell of an unwashed body) Ogden’s autistic-contiguous position posits experience of the feeling that one exists, for “the body [is] the first and founding entity upon which the subject’s identity is based.” The body is used in an attempt to repair and heal the internal void. In attempts to feel real or alive one may attack the body (e.g. self mutilation). Conversely, bodily sensations may be marginalized or corporeity rejected altogether (such as in Lombardi's clinical case of the man with anorexia nervosa; or in the extreme case of psychotic depersonalization). Therapists, then, may find verbal communication obfuscated by the predominance or exclusion, respectively, of the sensory-emotional dimension.

Relying on the work of Ferrari, Lombardi writes that “the continuous flow of sensations from the body” and “the intersection of sensations and thoughts” allow the “potential for expressing current emotions” such as ‘I am afraid’; I don’t feel well; I feel lost; you are beautiful; I love you; I hate you.’ “[T]hinking is deemed to be at all times connected with feeling.”

Delusions, obsessions, phobias, may be primitive sensory expressions, a necessary resort until more favorable conditions for mentalization present themselves “such as an encounter with an analytic reverie, which afford[s] an opportunity for…language proper and hence thought…[and for] the construction of a language to enable corporeity to speak.” Just as the mother’s reverie quells tensions allowing for mental space to process (‘receive and recognize’) the infant’s bodily sensations, providing an “area of transition from the concreteness of sensation to the first forms of abstraction and representability,” psychotherapy gingerly develops language to allow for symbolic expression and for the re-integration of the false duality between mind and body. Aptly put, Lombardi notes, “The function of analysis is to lead the analysand back to a real lived dimension so as to generate fragments of authentic experience.”


Lombardi, R. (2002). Primitive Mental States and the B... Ferrari's Concrete Original Object. Int. J. Psycho-Anal., 83:363-381.


Saturday, January 3, 2015

Attachment and Separateness

Both separateness and attachment develop our self identity. Mahlerian separation theories did not distinguish the development of the individual from development and maintenance of relationships, where, through internalization [a specious distinction between inside and outside], object constancy is eventually established allowing for more comfortable separateness. In contrast, attachment theories see the development of the individual as inherently interactive, with the self made up of past and present internal relationships. Relatedness, instead of the individual, is emphasized. Blass and Blatt speak of  the dialectic between separation (development of ‘self’) and attachment (the development of ‘self with other’), reminding us that it is not a linear process, but two distinct lines of development, whose progress in one line is essential to the other, each being continually renegotiated and reintegrated throughout the life cycle. The two primary developmental tasks, then, are the establishment of a consolidated, positive sense of self and the capacity to maintain mutually satisfying relationships. Within these interpersonal relationships, one learns to accept the limitations of the other, accept separateness and ambivalence.

Osofsky, likewise, sees the self as developing, and existing, within relationships. She notes that internalization of relationship experiences (of self as good and competent, or, conversely, self as bad and incompetent) become the internal representations, Bowlby’s internal working models—based on real life events – [and, perhaps, Stern’s RIGS, representations of interactions that have been generalized]. Early affect sharing and communication in the developing relationship between mother and infant contribute to the infant’s differentiation of self from other, that is, the self develops within the caregiver system [Winnicott’s no such thing as a baby]. The quality of this affect sharing and mutual regulation, affecting the quality of attachment, influence the child’s developing sense of self and of others. An infant can only “be competent to the extent that there is a caregiving environment that is alert and responsive to the infant’s ‘signals’.”  Meaning develops according to what the child means to the parent, and implicit rules of relating become the basis of the sense of self and the self with others. Later, “the analysand forms a relationship with the analyst that recreates and [hopefully] reworks old ‘working models’ of attachment figures.”

The self comes into being through interaction with important caregivers and through experiences of the self as separate. Blass and Blatt take Kohut’s ideas about the self as primarily a separate, self-contained  entity, and grapple with the paradox of self as continually embedded in relationship with others, that is, as also attached in loving relationship to others. They note that Kohut failed to emphasize that object ties (attachment) “can be based on other motives in addition to narcissistic ones.” They also point out how empathy as an expression of attachment can conflict with the self’s need to experience oneself as differentiated within a relationship, the “wish to be incomprehensible, obscure, [Winnicott’s private self] and thus separate.” Kohut struggled with whether to consider the selfobject experience as intrapsychic or interpersonal. Loewald put it in neither realm, but ‘in an intermediate region.’ Kohut spoke to relationships in regard to their contribution to self cohesion (that is, the other as selfobject), and distinguished object love and narcissism on degree of: differentiation between self and other; drive satisfaction; and contribution to self cohesion. Paradoxically, object love is attachment with increased differentiation, whereas the narcissistic aim is separateness (and intimates self interest) despite decreased differentiation (experiencing other as part of self, perhaps through projective identification).  In fact, write Blass and Blatt, “ongoing existence of others is experienced as an inherent and integral component of the individual’s cohesive sense of self separate and autonomous.” This paradox speaks to the speciousness of dichotomizing differentiation (separateness) and attachment for, as Blass and Blatt note, they are dialectically intertwined. Likewise, there is conflict and tension between the aims of attachment and autonomy. Thus, negotiation between autonomy (separateness) and relatedness (attachment), between self-sufficiency and dependency, is a universal human dilemma.

Blass, R.B., Blatt, S.J. (1992). Attachment and Separateness—A Theoretical Context for Integration of Object Relations Theory with Self Psychology.  Psychoanal. St. Child, 47:189-203.

Osofsky, J.D. (1995). Perspectives on Attachment and Psychoanalysis. Psychoanal. Psychol., 12:347-362.

Wednesday, December 17, 2014

novel Blindness; blind to recognition, containment, acceptance?

In Blindness— the 1995 novel by the Portuguese (1998) Nobel laureate for literature Jose Saramago— an epidemic of “white blindness” mysteriously renders all people, save one, blind, and chaos and cruelty ensue. Written without much punctuation the reader must, much like a therapist trying to make sense of the patient’s narrative, discern who is speaking to whom and about what. Blindness teems with allusions to our metaphorical blindness, such as people “behave as if they were afraid of getting to know each other.”  Saramago speaks to the sanctity of reciprocity: “I have no right to look if the others cannot see me,” and to the wrath – “some will hate you for seeing” –  of being the one who sees what all others are blind to (or disavow, like a parent who attacks the seeing child’s reality). There are moments of tenderness, such as when two blind lovers reunite: “how did they recognize each other…love, which people say is blind, also has a voice of its own,” and moments of despair when one’s true self goes unrecognized: “what good would it do her beautiful bright eyes…if there is no one to see them.”

Because all, save one, are blind, there can be no witness, yet some manage to find affective sharing when the blight can “convert strangers into companions in misfortune.” Despair overtakes many in this dark novel for “what meaning do tears have when the world has lost all meaning.” Even the one who is spared this affliction is incredulous to what becomes of those around her: “what shocked her was her disappointment, she had unwittingly believed that…her neighbors would be blind in their eyes, but not in their understanding.”

If blindness is, in part, the blindness to the need of the other, then I am reminded of Stuart Pizer’s 2014 paper The Analyst’s Generous Involvement: Recognition and the “Tension of Tenderness” which eloquently joins with and departs from Emmanuel Levinas’ idea of putting the suffering other above oneself. If one is to lean towards another’s need, one must first see (recognize) the need. Pizer takes Sullivan’s concept of the ‘tension of tenderness’: “the analyst’s recognition of a need or an affect state in the patient evokes an internal tug constituting the analyst’s need to provide for what has been recognized.” He writes, “An instinctual tug toward tenderness, or a spirit of generosity, in response to a recognized state of need in the Other is an inherent feature of our functioning attachment system.”

But how does a blind person see the Levinasian strange, transcendent, unfathomable ‘face’ of the other? Pizer sees generosity as instinctual, but expects Levinas to “reject instinct in favor of a subjectivity open to interruption, surrender, and awakening by an encounter with the Other.” Pizer continues, [we are] “wired to seek community, relational embeddedness, or ‘we-ness.’” Generosity sometimes requires of the analyst, per Corpt, an “unsettling re-evaluation and openness to amending any and all aspects of analytic practice in light of the patient’s forward edge strivings.” Pizer learned from his grandfather the healing power of the affectively resonant, witnessing presence of someone who recognized his need, and accepted him just as he was. Saramago notes its opposite, “Blindness is also this, to live in a world where all hope is gone.” That is, no hope of being seen, recognized, contained and accepted.


Pizer, S. (2014). The Analyst’s Generous Involvement: Recognition and the “Tension of Tenderness”. Psychoanal. Dial., 24:1-13.

Tuesday, December 9, 2014

Whose responsibility, anyway?

The task of the analyst is to help the patient learn about himself (discover the many facets of himself, if you will), not to impose on the patient the necessity to prove the analyst’s pre-learned theories about human behavior. The analyst, then, has no corner on ‘truth’ and cannot privilege her perspective over that of the patient’s psychic reality. Instead, both analyst and patient struggle to negotiate a working relationship toward discovery. Faltering, fumbling, rupturing, both then strive to upright and repair what has been lost in the relationship. No matter how both analyst and analysand are implicated in the co-creation of the transference, countertransference, or resistance, whatever the patient does is always in the service of trying to heal himself. The patient tests the analyst for trustworthiness, commitment, and circumspection. Make no mistake, that whatever the outcome—whether impasse, acquiescence, failure to improve, getting worse, or stopping treatment – it is always the analyst’s responsibility. The analyst  welcomes in, then must contain what has been welcomed. The analyst’s failure to monitor interactions between patient and analyst, to recognize and correct misattunements, can have dire consequences. While both take responsibility for the discourse, any failure lies on the shoulders of the analyst alone.

Tuesday, December 2, 2014

Revenge and Forgiveness

Because we all seek to maintain [or create anew] a sense of individual meaning, Lafarge writes that disruption of our sense of self can lead to the wish for revenge, “a ubiquitous response to narcissistic injury.” Revenge “serves to represent and manage rage and to restore the disrupted sense of self [and restore the] internalized imaging audience [the other].” Narcissistic injury is a disruption to meaning and self value and to the story of one’s experience. In efforts to reestablish meaning and to construct a story, as well as create a witness to one’s story, the avenger uses anger and revenge to consolidate early experiences (a time when the “imagining parent” [like Bion] helped construct the infant’s mind with meaning and with its representations of self and others). Communicating experience and constructing its story is also present in the revenge. It is a way of being seen and heard and helps maintain the tie to the lost, imagining parent. Thus, revenge can ward off object loss [Searles] and hatred can be an early form of object constancy. “Giving up the wish for revenge requires the avenger to recognize the rage and helplessness that are warded off…[and] involves acknowledgement of a transient disruption of self experience” that they accompany.

Lansky tells us that shame gives rise to rage as a strategy to protect one’s sense of self from the awareness of helplessness, abandonment, betrayal. Sometimes, clinically, it is easier to analyze the visible rage and resentment than its underlying shame, but it is the detailed exploration of shame that sheds light on its unbearableness. When one’s sense of self is chronically disrupted from the betrayal by needed and beloved others, attachment is at risk. All future attachment is at risk, for who wants to be duped again, subject to humiliation and shame? The disrupted self, in valiant efforts to reconstitute a self representation that can be lived with, may need to withdraw and isolate, project, omnipotently control, split, or retaliate. The latter, as revenge, can seemingly restore a sense of power and effectiveness as well as protect against awareness of vulnerability. Revenge also protects against the uncertainty of forgiveness. Only awareness of loss and its mourning can circumvent the need to humiliate the other, leading to forgiveness both of self and other.


LaFarge, L. (2006). The wish for revenge. Psychoanal. Quart., LXXV, pp. 447-475.

Wednesday, November 26, 2014

Ferguson and Thanksgiving

In the wake of Ferguson, MO’s Grand Jury decision not to indict a white police officer’s killing of a black teenager, residents expressed their concerns. Whether police brutality or self defense, black young men are in danger, agravated by lack of accountability on too many sides. One mother tearfully asked, “What am I to tell my son when he grows up?...You try to have hope.” Another woman tearfully expressed a more universal need, “We just hope for one time that our lives will matter; that somebody will see that our lives are valuable.” This latter plea speaks to the human motivation to be seen, to be recognized for who we are and still be accepted.

As we gather around the Thanksgiving table with our families of origin and the families we have made, may we take a break from seeing what we expect and, instead, look anew from an other’s point of view, accepting her or him just the way they are, and, hopefully, being accepted in return. What might we be thankful for? That in the best of relationships we are loved, warts and all.


Wishing a Happy Thanksgiving to you and yours.

Thursday, November 20, 2014

Dissociation and Enactment

Unlike Kohut, who believed in a unitary self and thought health was an increased cohesiveness in one’s sense of self, Bromberg says that we all exist in a multiplicity of self states, each with its own memory, experience, and unconscious. “Health is not integration. Health is the ability to stand in the spaces between realities without losing any of them.” (p.186), that is, it is simultaneous awareness of these many discrete selves.  The sense of a unitary self, writes Bromberg, is an adaptive illusion. Dissociation of certain self states, with their untenable affects (such as shame) occurs in all of us, often in response to the traumas of misattunement, misrecognition, or attacks on our reality. Bromberg recommends that analysts learn to see the validity of a patient’s psychic reality alongside their own, careful not to claim ownership of arbiter of reality. In this capacity to see both realities, space is made to construct consensual meaning. Their relationship is continually renegotiated.

Sometimes the only way to access dissociated experience is through enactments which can painfully draw the analyst into the early object relations of the patient. Sometimes these enactments additionally allow the patient to see his impact on the analyst. Enactments are

…an example of what Levi (1971) called “a powerful though perverted attempt at a self cure” (p.184). It involves a need to be known in the only way possible – intersubjectively—that is different from the old and fixed patterning of self-other interactions, a version of the situation that led to the original need for dissociation. (p.172)

For a patient in analysis to look into his own nature with perceptiveness, and to utilize creatively what is being enacted, there must exist a simultaneous opportunity for the patient to look into the analyst’s nature with an equivalent sense of freedom and security. (p.176)

In the clinical situation, those patients with the most dissociation, often called personality disorders, cannot resonate with interpretations which address conflict because, until contradictory self states are in simultaneous awareness, the contradiction/conflict cannot be 'seen' by the patient. Because psychic reality varies by self state, an issue already explored in one self state may come up again later in another self state. As one candidate noted to herself as her patient spoke, "Didn't we already go over this!" In this 'Groundhog Day' phenomenon, and the going over and over the same ground, is what I like to call 'the joy of Sisyphus,' and the candidate asks, "So where's the joy?"





From STANDING IN THE SPACES: Essays on Clinical Process, Trauma, and Dissociation (1998). Psychology Press. New York, London; Chap. 12, Shadow and Substance.

Tuesday, November 18, 2014

Envy as refused desire

Gerhardt’s rich paper on the intersubjective contribution of envy elucidates the part played by the mother’s (and analyst’s) failure to identify with the infant (later, analysand). Unlike Klein who saw envy as primary and related to aggression and the death instinct, Gerhardt frames envy in terms of refused desire. She sees envy as secondary to thwarting of this wish to be at one with the object, to both have and be the object, to matter to the object, as when the mother refuses to accept desire from the child as well as fails to help the child feel desired by her. The failure of the mother to adapt to the needs of the infant and her failure to see the infant’s demands for recognition as legitimate, renders her unable as well to experience maternal identification with the infant’s (secondary) envy. When the analyst (or mother) dissociates her own disavowed envy, dependence, and shame, she cannot identify with the patient’s split off self-states, and is less able to contain and transform them for the patient’s use. Gerhardt’s patient felt contained when Gerhardt invites and sustains a kind of one-ness, in part, through the analyst’s mutual identification with her patient, rendering horrible affects less terrifying.

Gerhardt writes that envy results when the “normal identificatory processes have gone awry,” and quotes Benjamin: “when desire to identify goes unanswered, envy takes its place.” [I think of penis envy and father’s rejection –or mother’s prohibition— of the female child’s identification with the father.] Envy, for Gerhardt, is an attempt at “denial of difference” and “repudiation of dependency” in response to the mother’s failure to identify with and manage the infant’s expelled and intolerable states, in particular those in which the infant (later, analysand) feels abject and defective, full of shame.  Envy, then, is also secondary to shame. Gerhardt also invokes Bion’s “protesting the separation between knower-known” [which calls to mind the humiliation engendered in the patient when the analyst insists on being the only ‘knower’ in the dyad]. [As an aside, she reminds us that Bion had noted that the mother’s failure to contain the infant’s fear evokes in the infant “nameless dread.”]

Oelsner takes the classic object relations approach, taking umbrage with Gerhardt seeing aggression and envy as secondary, and recommends the repeated analysis of aggression. He reminds us that Bion conceived of envy as an attack on linking. Envy destroys otherness by denying, through projective identification, recognition of separateness. Ornstein, on the other hand, as a self psychologist, agrees with Gerhardt that envy is secondary (this time, to empathic failure of participation of the analyst’s subjectivity and rejection of patient’s efforts) and sees Gerhardt’s eventual capacity to empathize with her patient— by giving up her “decoding interpretations” (experienced by the patient as “counter-attacks”) and by recognizing her part in thwarting the patient’s desires. Ornstein recommends seeing what transpired between them not as an attack by patient on analyst, but as a forward edge in terms of being able to make a demand of the analyst that the patient could not make as a child on her mother.

Gerhardt, J. (2009). The Roots of Envy: The Unaesthetic Experience of the Tantalized/ Dispossessed Self. Psa. Dial., 19:267-293
Oelsner, R. (2009). One Envy or Many?: Commentary on Paper by Julie Gerhardt. Psa. Dial., 19:297-308.
Ornstein, P.H. (2009). A Comparative Assessment of an Analysis of Envy: Commentary on Paper by Julie Gerhardt. Psa. Dial., 19:309-317